Glucose and insulin changes in infants and children undergoing hypothermic open-heart surgery

Area of Science:

• Pediatric Cardiac Surgery
• Metabolic Response to Surgery
• Anesthesiology

Background:

• Hypothermic open-heart surgery is associated with marked hyperglycemia in pediatric patients.
• The underlying mechanisms for this hyperglycemia, particularly in relation to insulin response, require further investigation.

Purpose of the Study:

• To evaluate the mechanisms responsible for hyperglycemia during hypothermic open-heart surgery in pediatric patients.
• To assess the relationship between glucose and insulin levels in different surgical scenarios.
• To provide recommendations for glucose management during pediatric cardiac surgery.

Main Methods:

• Paired glucose and insulin levels were measured in three groups of pediatric patients undergoing cardiac surgery with varying degrees of hypothermia and circulatory arrest.
• A fourth group received restricted glucose infusion to assess its impact on hyperglycemia.
• Analysis of metabolic responses in relation to surgical conditions.

Main Results:

• All surgical groups exhibited significant hyperglycemia during and after open-heart surgery.
• Insulin levels did not increase proportionally to the elevated glucose levels, indicating an impaired insulin response.
• Restricting intraoperative glucose infusion in a separate group prevented the development of hyperglycemia.

Conclusions:

• Pediatric patients undergoing hypothermic open-heart surgery experience hyperglycemia primarily due to an insufficient insulin response.
• Intraoperative hyperglycemia can lead to misinterpretation of cardiorenal function due to osmotic diuresis.
• Recommendations include avoiding glucose in pump prime solutions and intraoperative fluids, opting for balanced electrolyte solutions instead.