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Glucose homeostasis during anesthesia and surgery in infants
Insights
Neonates and infants undergoing surgery often develop hyperglycemia, a condition where blood glucose levels are too high. Monitoring glucose and using dextrose-free fluids during surgery is recommended for these pediatric patients.
Area of Science:
- Pediatric Surgery
- Neonatal Metabolism
- Anesthesia Endocrinology
Background:
- Perioperative glucose metabolism in neonates and infants is complex.
- Surgical stress can significantly impact metabolic regulation.
- Understanding hormonal and glucose changes is crucial for patient management.
Purpose of the Study:
- To investigate plasma glucose, insulin, and cortisol levels in neonates and infants during surgical procedures.
- To identify factors influencing perioperative hyperglycemia in this population.
- To provide recommendations for fluid management during surgery.
Main Methods:
- Plasma samples collected at baseline, preinduction, postinduction, and postsurgery.
- Analysis of glucose, insulin, and cortisol levels in 16 neonates and infants.
- Constant glucose infusion rate maintained; dextrose-free fluids used for replacement.
Main Results:
- Plasma glucose significantly increased postinduction and further postsurgery.
- Postsurgical hyperglycemia (glucose > 150 mg/dL) occurred in 10/16 infants.
- Higher postsurgical glucose levels correlated negatively with infant weight.
- Cortisol levels increased significantly by the end of surgery.
Conclusions:
- Hyperglycemia is common in neonates and infants undergoing surgery.
- Glucose monitoring is essential during surgical procedures.
- Dextrose-free intravenous fluids are recommended for fluid replacement to manage hyperglycemia.
Abstract:
Baseline, preinduction, postinduction, and postsurgical plasma samples were collected for glucose, insulin, and cortisol in 16 neonates and infants. Glucose infusion rate was maintained constant (mean +/- SD 4.1 +/- 1.2 mg/kg/min) prior to and during surgery; additional fluid losses during surgery were replaced by fluids without dextrose. The weight at the time of surgery was 3,038 +/- 1,397 g. Postnatal age at the time of study ranged from one day to 40 weeks and the duration of surgery was 83 +/- 35 minutes. Plasma glucose values were higher than baseline values soon after induction of anesthesia (88 +/- 11 v 130 +/- 36 mg/dL; P less than .05); postsurgical glucose values were significantly higher than postinduction values (210 +/- 109 mg/dL v 130 +/- 36 mg/dL, P less than .01). Postsurgical plasma glucose had a negative correlation with weight of infants at the time of study (P less than .01; r = .61). Insulin changes were minimal and variable. Cortisol values did not change significantly from baseline values until the end of surgery (11.9 +/- 8.3 v 22.2 +/- 10.6 micrograms/dL; P less than .05). Hyperglycemia (greater than 150 mg/dL) was noted in 10/16 infants. This study indicates that glucose levels should be monitored and that additional fluid losses should be replaced by fluids without dextrose in neonates undergoing surgical procedures since hyperglycemia is a common occurrence.