European Journal of Cardiovascular Medicine

Effective perioperative fluid management in pediatric patients undergoing anesthesia is crucial for optimizing surgical outcomes and ensuring patient safety. The unique physiological characteristics of children, including higher body water content, immature renal function, and elevated metabolic rates compared to adults, present distinct challenges in fluid administration [1,2]. Despite its critical importance, there is limited comprehensive data on the knowledge, attitudes, and practices (KAP) of healthcare professionals in this area, particularly within the context of developing nations such as India [3].

This cross-sectional study aims to address this knowledge gap by evaluating the KAP of consultant anesthesiologists and residents concerning perioperative fluid management in pediatric patients at a tertiary healthcare facility in India. The significance of this research lies in its potential to highlight strengths and identify deficiencies in current perioperative fluid practices for pediatric patients [3]. By assessing the knowledge base, exploring attitudes, and examining the practices of healthcare professionals, this study aims to provide insights that can inform targeted educational programs, policy formulation, and quality improvement initiatives in pediatric anesthesia care [1].

Moreover, this study is particularly relevant in the Indian healthcare setting, where variations in training, resources, and protocols across different institutions may impact perioperative fluid management practices. The findings from this tertiary care facility could establish a benchmark for similar institutions nationwide and guide the development of standardized protocols for perioperative fluid management in pediatric anesthesia[3].

Through a detailed analysis of KAP among healthcare providers, this study aspires to contribute to the enhancement of perioperative care for pediatric patients, ultimately leading to improved surgical outcomes and patient safety in the field of pediatric anesthesia in India and similar healthcare environments globally [2]

The study will be conducted in the Department of Anesthesia at a tertiary care hospital in Karnataka. The study sample will include all doctors from the Department of Anesthesia who have given their consent to participate, encompassing all postgraduate residents. A questionnaire in English, developed with expert advice in the respective field, will be distributed via Google Forms. The questionnaire has been validated by the first 10 respondents, and minor changes have been made accordingly.

Inclusion Criteria

The study includes consultants and residents from the Department of Anesthesia at the tertiary care hospital in Karnataka.

Exclusion Criteria

• First-year and second-year residents who have not yet rotated in the pediatric surgery department, NICU, and PICU for at least one week each.
• MBBS interns posted in Anesthesia and other departments.
• Nursing and paramedical staff working in the hospital.

The criteria for inclusion and exclusion were strictly adhered to. Only those doctors who fulfilled these criteria and gave their consent were meticulously interviewed and examined.

After data collection, appropriate statistical methods will be employed for analysis. Qualitative data will be expressed in terms of proportions and percentages, while quantitative data will be depicted through averages and standard deviations.All statistical analyses will be performed using SPSS (Statistical Package for the Social Sciences) version 23, Apple Pages, and Numbers Version 13.2.

. Experience and Satisfaction:

Our study found a significant association (p=0.005) between experience level and satisfaction with current fasting practices. Residents were more likely to be satisfied (94.12%) compared to consultants (5.88%). This finding contrasts with the study by Ferrari et al. (1999), which found no uniform fasting practice across institutions, regardless of experience level [4]. The discrepancy might suggest an evolving landscape in pediatric fasting practices, with newer guidelines potentially influencing resident education and satisfaction.

2. Age-specific Fasting Criteria:

Our study revealed that 88.24% of satisfied anesthesiologists treated neonates, infants, and children as separate age groups with different fasting criteria (p=0.015). This aligns with the review by Zhang et al. (2023), which highlighted that pediatric fasting guidelines typically categorize intake based on age groups and types of intake (clear fluids, breast milk, formula, and solids) [7]. This practice is supported by evidence showing age-related differences in gastric emptying and metabolic responses to fasting.

3. Hydration Method:

Our study found a significant preference (p=0.047) for oral hydration (70.59%) among satisfied anesthesiologists. This aligns with recent trends in liberalizing clear fluid intake, as noted in the Practice Guidelines for Preoperative Fasting by the American Society of Anesthesiologists [5]. These guidelines recommend clear fluid intake up to 2 hours before procedures, which has been associated with improved patient comfort and reduced preoperative anxiety.

4. Fluid Choice:

While our study found no significant association between fluid choice and satisfaction (p=0.339), dextrose saline was the most preferred option (58.82% among satisfied anesthesiologists). This preference aligns with the findings of Dennhardt et al. (2015), who reported that prolonged fasting times significantly impacted blood glucose concentration and acid-base balance in young children [8]. The use of dextrose-containing fluids may help mitigate these metabolic effects.

5. Logistical Issues:

Our study identified logistical issues preventing pre-arranged IV therapy as a significant factor (p=0.047) associated with dissatisfaction. This echoes findings from the study by Engelhardt et al. (2011), which reported prolonged fasting times often due to logistical issues rather than medical necessity [4].

6. Replenishing Fluid Deficits:

While not statistically significant (p=0.321), our study found that 58.82% of satisfied anesthesiologists normally replenish fluid deficits during the anesthetic period. This practice aligns with the concept of Enhanced Recovery After Surgery (ERAS) protocols, which emphasize optimizing perioperative fluid management [6].

Limitations of the study:

The study's small sample size (n=22) limits its generalizability and statistical power, potentially affecting the robustness of its conclusions. The survey design may not capture all relevant factors influencing satisfaction levels or practice patterns, with unmeasured confounders possibly impacting data interpretation. A significant limitation is the absence of direct correlation with patient outcomes, which are crucial for assessing the real-world impact of different fasting protocols. This lack of patient outcome data restricts the study's ability to draw definitive conclusions about the efficacy of various perioperative fasting practices.

The burden of foot complications within community does not seems to be insubstantial, however many patients in this tertiary care-centre does not have accessibility for the podiatry services. The study persuaded to follow an empirical study, having both quantitative and qualitative assessment. The participants include the health-care professionals and patients of hospital expressed their keenness which accepts for getting accessibility towards the specialised podiatry-services. The assessment of the location, reveals that none of specialised podiatry-clinic were available in the study area, however one tertiary care-centre were there but it has informal podiatry-services. Most of primary-care and secondary care in neighbour-hood area does not have accessibility for providing podiatry services. Hence this study, paves the pathway, as the feasibility study about the location, regarding the establishment of podiatry department within hospital.

Future Recommendations

The diverse and wide level of barriers to establish the podiatry-unit, which limit the ability of hospital practitioners to differ the routing practices of clinics ought to get addressed. To identify the podiatric practices domain necessary for the competent methods, might offer the suitable framework, to ensure that all the major podiatry skill areas could be targeted through change process initiatives. A proper future podiatry vision can be made for encouraging the open-learning culture, wherein the podiatrist professional share unsuccessful and successful attempts, for varying the current practices. In order to deliver the bottom-up change, the concept of flexibility seems necessary in the system, in terms of day to-day practices and hospital structure. However, if the podiatry unit has been established, the multi-disciplinary collaboration and working among the peers and inside the organisation results to wide personal professional benefits, patient benefits and the operational benefits. A prominent move towards the high multi-disciplinary working podiatry methods would thus nurture a focussed desire and high positive mind-set in implementing a change within tertiary care-centre. Additionally efficient personal and operational change programmes, could be high reflective, and such collaborative practices construct healthy, working and supportive relationship among the professionals and patients. This thrives as essential aspect to enhance the population and patient’s health outcomes

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