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Intraoperative glycemic control without insulin infusion during pediatric cardiac surgery for congenital heart
Thierry V Scohy1, Hanna D Golab, Mohamud Egal
1Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands. t.scohy@erasmusmc.nl
Insights
Standard pediatric cardiac anesthesia without insulin is sufficient for most children undergoing heart surgery. However, close monitoring for hyperglycemia is crucial in neonates with complex congenital heart conditions.
Area of Science:
- Pediatric Cardiac Anesthesiology
- Congenital Heart Disease Management
- Intensive Care Medicine
Background:
- Hyperglycemia post-cardiac surgery in children correlates with increased morbidity and mortality.
- This study evaluated blood glucose levels during standard pediatric cardiac anesthesia without insulin infusions.
Purpose of the Study:
- To assess blood glucose control in pediatric patients undergoing cardiac surgery with a specific anesthetic protocol.
- To identify factors associated with hyperglycemia in this population.
Main Methods:
- 204 pediatric patients (3 days-15.4 years) undergoing open cardiac surgery were studied.
- Glucose-containing fluids were avoided; high-dose opioids and steroids were administered.
- Blood glucose was monitored at multiple intraoperative and intensive care unit (ICU) time points.
Main Results:
- 27.9% of patients had intraoperative glucose >180 mg/dL, but only 5.8% had levels >180 mg/dL upon ICU arrival.
- Thirty-day mortality was 1.5%.
- Younger age, lower body weight, lower cardiopulmonary bypass (CPB) temperature, and higher severity scores were linked to hyperglycemia at ICU arrival.
Conclusions:
- Conventional anesthetic management without insulin is effective for most pediatric cardiac surgery patients (96.5%).
- Neonates undergoing complex congenital heart surgery require careful attention, and insulin therapy may be considered for them.
Background:
Many studies are reporting that the occurrence of hyperglycemia in the postoperative period is associated with increased morbidity and mortality rates in children after cardiac surgery for congenital heart disease. This study sought to determine blood glucose levels in standard pediatric cardiac anesthesiological management without insulin infusions.
Methods:
The study population consisted of 204 consecutive pediatric patients aged from 3 days to 15.4 years undergoing open cardiac surgery for congenital heart disease between June 2007 and January 2009. Glucose-containing fluids were not administrated intraoperatively, and all patients received high dose of opioids (sufentanil 10 mcg·kg(-1) ) and steroids (30 mg·kg(-1) methylprednisolone) iv. Glucose levels were measured before CPB, 10 min after initiation of CPB, every hour on CPB, post-CPB, and on arrival at intensive care unit (ICU).
Results:
Intraoperatively, only one patient had a glucose level <50 mg·dl(-1) (=34.2 mg·dl(-1) ), 57/204 patients (27.9%) had at least one intraoperative glucose >180 mg·dl(-1) , but only 12 patients (5.8%) had a glucose level >180 mg·dl(-1) at ICU arrival. Thirty-day mortality was 1.5% (3/204). Younger age, lower body weight, and lower CPB temperature were associated with hyperglycemia at ICU arrival, as were higher RACHS and Aristotle severity scores.
Conclusion:
A conventional (no insulin, no glucose) anesthetic management seems sufficient in the vast majority of patients (96.5%). Special attention should be paid to small neonates with complex congenital heart surgery, in whom insulin treatment may be contemplated.
