The main aim of a perioperative fluid therapy is to maintain or normalize the patient’s homeostasis. Small children have higher fluid volumes, metabolic rates and fluid needs than adults. Therefore, short perioperative fasting periods (formula milk 4 hours, breast milk 3 hours, clear fluids 1 hour) are important to avoid iatrogenic dehydration, hypotension, ketoacidosis and uncooperative behavior. Balanced electrolyte solutions with 1–2.5% glucose are favored for intraoperative maintenance infusion. Glucose- free balanced electrolyte solutions should then be added as needed to replace intraoperative fluid deficits or minor blood loss. Gelatin solutions or hydroxyethyl starch are useful in hemodynamically unstable patients or those with major blood loss, especially when crystalloids alone are not effective and blood products are not indicated. The monitoring should focus on the maintenance or restoration of a stable tissue perfusion.In nonsurgical or postoperative children, balanced electrolyte solutions should be used instead of hypotonic solutions, both with 5% glucose, as recent clinical studies and reviews showed a lower incidence of hyponatremia.

Fluid administration is one of the basic components in the management of neurosurgical patients. However, there is still debate on the ideal fluid. Issues related to adequate volume replacement and effects on the intracranial pressure persist. Studies have demonstrated the harmful effects of colloids over crystalloids. Normal saline has remained a fluid of choice but there is now emerging evidence that it, too, is not free of its harmful effects. Hypertonic saline has also been accepted by many practitioners, but its use and administration require close monitoring. There is now growing evidence on the use of balanced solutions for neurosurgical patients. However, this evidence comes from a small number of studies. Hemodynamic monitoring for fluid therapy in these patients is prudent as these patients are prone to hypovolemia. Dynamic parameters like stroke volume variance and pulse pressure variance are considered more reliable to monitor fluid therapy in comparison to static parameters. This chapter briefly covers various clinical situations in neurosciences with respect to fluid therapy and use of hemodynamic monitoring while providing fluid therapy and its effect on patient outcome.