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The effect of intravenous dextrose infusion on postbypass hyperglycemia in pediatric patients undergoing cardiac
1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510.
Insights
Eliminating intraoperative dextrose infusions in pediatric cardiac surgery patients significantly reduced post-cardiopulmonary bypass hyperglycemia. This strategy effectively controls blood glucose levels without causing hypoglycemia.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Hyperglycemia following cardiopulmonary bypass (CPB) is a common complication in pediatric cardiac surgery patients.
- The impact of intraoperative dextrose-containing infusions on post-CPB glucose levels in this population is not fully understood.
Purpose of the Study:
- To investigate whether omitting dextrose infusions during intraoperative periods influences post-cardiopulmonary bypass hyperglycemia in pediatric patients undergoing cardiac surgery.
Main Methods:
- A randomized, unblinded, saline-controlled study was conducted involving 33 non-diabetic children undergoing cardiac surgery with deep hypothermia.
- Patients were divided into two groups: one receiving normal saline (Group A) and the other receiving 5% dextrose and lactated Ringer's solution (Group B) intraoperatively.
- Blood glucose levels were monitored at multiple time points, including pre- and post-CPB, on ICU arrival, and on the first postoperative morning.
Main Results:
- Group B (dextrose infusions) exhibited significantly higher post-CPB blood glucose levels (mean > 250 mg/dl) compared to Group A (saline only, mean < 165 mg/dl).
- No instances of hypoglycemia (glucose < 40 mg/dl) were observed in either group.
- Blood glucose normalized by the first postoperative morning in both groups, irrespective of intraoperative dextrose administration.
Conclusions:
- Eliminating intraoperative dextrose infusions is an effective strategy to control extreme hyperglycemia after cardiopulmonary bypass in pediatric cardiac surgery patients.
- Hypoglycemia is an unlikely complication and can be prevented with routine arterial catheter monitoring.
Study Objective:
To determine whether elimination of intraoperative dextrose-containing infusions affects post-cardiopulmonary bypass hyperglycemia in pediatric patients.
Design:
Randomized, unblinded, saline-controlled study of perioperative glucose infusions in children undergoing cardiac surgery.
Setting:
Cardiac surgery suite and pediatric intensive care unit (ICU) of a university medical center.
Patients:
33 consecutive, nondiabetic children undergoing cardiac surgery with deep hypothermia over an 8-month period.
Interventions:
Group A (n = 16) received only normal saline infusions intraoperatively, and Group B (n = 17) received 5% dextrose and lactated Ringer's solution exclusively. Blood glucose was sampled immediately after induction of anesthesia, prior to cardiopulmonary bypass (CPB), after separation from CPB, on arrival in the ICU, and the morning of the first postoperative day. Data were analyzed using Student's t-test for independent samples, paired t-test, and analysis of variance, with p < 0.05 considered significant.
Measurements And Main Results:
Although moderate elevations in blood glucose (mean less than 165 mg/dl) after CPB were present in Group A, significantly higher levels (mean greater than 250 mg/dl) were noted in Group B. No children were hypoglycemic (glucose less than 40 mg/dl). Glucose levels were normal in both groups on the morning of the first postoperative day despite patients' having received continuous dextrose infusions in the ICU and the presumed stress of emergence from anesthesia.
Conclusions:
Extreme postbypass hyperglycemia can be controlled by eliminating intraoperative dextrose infusions. Hypoglycemia, an unlikely event, can easily be avoided by regular blood sampling, which is facilitated by the routine placement of arterial catheters.