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Glucose: a reevaluation of its intraoperative use in paediatric surgery
1Department of Anaesthesiology and Intensive Care, Universiti Kebangsaan Malaysia, Kuala Lumpur.
Insights
Lactated Ringer's (LR) solution is safe for pediatric surgery. Giving 5% dextrose in LR intraoperatively increased blood glucose more than LR alone, suggesting LR is sufficient for intraoperative fluid therapy in children.
Area of Science:
- Pediatric Anesthesiology
- Intraoperative Fluid Management
- Metabolic Monitoring
Background:
- Maintaining stable blood glucose levels is crucial during pediatric surgery.
- Intraoperative fluid choices can impact glycemic control in children.
- Previous research has not definitively established the optimal fluid for glycemic stability in pediatric surgical patients.
Purpose of the Study:
- To compare the effects of lactated Ringer's (LR) solution versus 5% dextrose in lactated Ringer's (5%D/LR) on blood glucose concentrations in children undergoing surgery.
- To determine if LR alone is adequate for intraoperative fluid therapy in pediatric patients.
Main Methods:
- A randomized controlled trial involving 100 children undergoing surgery.
- Children received either LR or 5%D/LR as intraoperative maintenance and replacement fluids.
- Blood glucose levels were measured before and at multiple time points during surgery using a reflectance meter.
Main Results:
- No patients experienced hypoglycemia pre- or intraoperatively.
- Both LR and 5%D/LR groups showed a significant increase in blood glucose from preoperative levels (p < 0.05).
- The increase in blood glucose was significantly greater in the 5%D/LR group compared to the LR group (p < 0.05).
- Hyperglycemia was more frequent in children receiving 5%D/LR.
Conclusions:
- Lactated Ringer's solution alone is a safe and appropriate fluid for intraoperative fluid therapy in children.
- The use of 5% dextrose in LR leads to a greater increase in intraoperative blood glucose concentrations compared to LR alone.
- Routine intraoperative dextrose administration may not be necessary for glycemic control in pediatric surgical patients.
Abstract:
Blood glucose concentration was measured in 100 children immediately before and during surgery. These children were randomly assigned to receive either lactated Ringer's (LR) solution or 5% dextrose in lactated Ringer's (5%D/LR) intraoperatively as maintenance and replacement fluids. Blood samples were taken immediately after induction of anaesthesia and at 1/2, 1, 1.5, 2 and subsequent hours. Blood glucose concentration was assayed by a reflectance meter. None of the patients was noted to be hypoglycaemic pre- and intraoperatively. Intraoperative blood glucose concentration increased significantly (p < 0.05) from preoperative levels for both groups of children but the increase in those that received 5%D/LR was significantly greater (p < 0.05) than those who received LR. The number of children who were hyperglycaemic during surgery was also greater in those who received 5% dextrose in lactated Ringer's as their intraoperative fluid. These data suggest that lactated Ringer's alone is a safe and appropriate fluid for intraoperative fluid therapy in children.