J.Jpn. Surg. Soc.. 62(8): 817-836, 1961
STUDIES ON THE FLUID THERAPY IN THE SURGICAL PATIENT OF THE AGED AND CHILDHOOD
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Surgical Department, Sagamihara National Hospital (Director: Drs. Soiti YANAGI and Tosio TAKAHUZI) Yutaka ASUKAI |
I have studied on the fluid therapy about the aged surgical patients in the pre-and postoperative period. In this study, the metabolic exchange of water and electrolytes in aged patients has been determined, and some experiments have been added.
The results obtained are summarized as follows :
1) The levels of serum electrolytes in the healthy aged was found same as that in the adult, but the total body water content was lower than that of adult, and extracellular fluid volume showed relatively increased.
2) The gastric and enteric cleaning, used generally as preoperative treatment for abdominal surgery, had a great influence to the aged patients. Fluid therapy must be considered in these cases.
3) In anesthesia, especially in premedication such as opiumscoporamine injection, a great influence has been found in the aged patients. Therefore, the selection of anesthetic agents and their dosage was a most important management for the aged poor risk patients. Endotracheal anesthesia was a suitable method for the aged patients at the part of water and electrolytes balance.
4) In the aged patients, circulating plasma volume decreased by operative bleeding was more than that in the adult. So that a careful fluid therapy must be considered for hypoproteinemic and chronic diseases.
5) The insensible fluid loss in the aged patients was less than that of adult group.
6) In the aged patient, the exchange of tissue water contents at the site of operation was slightly less than that in the adult.
7) Negative water balance has been shown by infusion of 20 c.c. per kg. body weight in the minor abdominal operation of the aged patients . The mixed infusion, such as glucose, amino-acid and Ringer's solution was the most advisable for the maintenance of serum electrolyte levels.
8) On the postoperative progress of the gastric ulcer at the same treatment in the aged and adult, the former indicated positive primary water balance, and this nitrogen output was less than that of the latter. Reasonable infusion volume was considered 35 c.c. per kg. body weight.
9) The volume of juice by postoperative gastric suction in gastric ulcer was larger than the others, in the aged surgical patients. But generally, the volume of adult's gastric juice was larger than that of aged. Electrolyte content of gastric juice was little less than adult's. The period of gastric suction of the aged was shorter than that of adult. In this therapy, a good condition has been found at electrolytes balance in the aged patients, when supplied the fluid as same as in the adult. (Author's abstract)
Part 2. STUDIES ON THE FLUID THERAPY IN THE SURGICAL PATIENT OF THE CHILDHOOD
As the studies on the fluid therapy in surgical child patients, I have estimated the metabolic exchange of water and electrolytes, in pre-and postoperative period.
The results obtained are as follows :
1) The values of serum electrolytes in the healthy child were same as that in the adult, and the total body water and extracellular fluid volume were more than in the adult in most cases. But these levels in 10 to 15-year-old child draw up to that in the adult.
2) The metabolic exchanges of water and electrolytes in surgical child patients were came out very rapidly, and the values of electrolytes have been shown lower than that of the grown ups.
3) Insensible fluid loss of childhood was more than that of the adult.
4) Even at the minor operation of childhood, the change of water and electrolytes balance was found very large, comparing with that of the adult.
5) The tissue water contents was more than the adult's, and the variety rate of tissue water content was larger, but returned to preoperative level rapidly.
6) Postoperative oliguria was seen frequently in the surgey of childhood, but the effect of fluid therapy appeared apparently and rapidly.
7) At the postoperative fluid therapy, the water balance has tended to negative, when given the same volume of fluid per kg. body weight in adult patient. And in the major operation of ileus, peritonitis etc., this tendency was far more remarkable.
8) Reasonable infusion volume in 5 to 10-year-old child was considered to be 50-60 c.c. per kg. body weight of water and 0.1 gram per kg. body weight of sodium chloride.
(Author's abstract)
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