Related Experiment Videos
Comparison of two solutions with different glucose concentrations for infusion therapy during laparotomies in infants
1Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik des Saarlandes, Hornburg/Saar.
Insights
Infant intraoperative infusion therapy with 5.5% glucose solutions caused hyperglycemia in both age groups. Younger infants also experienced hyperglycemia with 2.5% glucose, suggesting separated glucose and fluid administration is needed for infants undergoing abdominal surgery.
Area of Science:
- Pediatric Anesthesiology
- Intraoperative Fluid Management
- Metabolic Monitoring in Infants
Background:
- Infants undergoing laparotomy require careful intraoperative infusion therapy.
- Standardized anesthetic techniques, including caudal blocks, are used.
- Two commercially available glucose-containing solutions were compared.
Purpose of the Study:
- To compare two commercially available infusion solutions for intraoperative therapy in infants undergoing laparotomy.
- To evaluate the impact of different glucose concentrations on blood glucose levels in two infant age groups.
- To assess electrolyte and hemoglobin concentrations during surgery.
Main Methods:
- Prospective, randomized study involving 24 infants (1-14 months) divided into two age groups.
- Infants received either Solution A (2.5% glucose, 70 mmol Na+) or Solution B (5.5% glucose, 100 mmol Na+) at 8 ml/kg/h.
- Blood glucose, electrolytes, and hemoglobin were monitored, along with urine output and concentrations.
Main Results:
- Both solutions led to significant increases in blood glucose during surgery.
- Younger infants (1-12 weeks) showed intolerable hyperglycemia with both solutions.
- Older infants (5-14 months) receiving Solution B had significantly higher blood glucose levels compared to Solution A after 1, 2, and 3 hours.
Conclusions:
- Infusion solutions with 5.5% glucose at 8 ml/kg/h cause hyperglycemia in infants.
- Even 2.5% glucose solutions can lead to hyperglycemia in younger infants.
- Separating glucose and fluid administration is recommended for young infants undergoing abdominal surgery, with close blood glucose monitoring.
Objective:
Comparison of two commercially available solutions for intraoperative infusion therapy during laparotomies in infants using a standardized anesthetic technique (combination of general anesthesia with a caudal block).
Design:
Prospective, randomized.
Setting:
Infusion therapy during laparotomies in infants.
Patients And Methods:
12 infants aged 1-12 weeks (group I) and 12 infants aged 5-14 months (group II) received at random either solution A with 2.5% glucose and 70 mmol Na+ or solution B with 5.5% glucose and 100 mmol Na+ at a rate of 8 ml/kg/h.
Interventions:
Central venous blood samples after induction of anesthesia and every 60 min for analysis of blood glucose, electrolyte, and hemoglobin concentrations. End of surgery: urine output during the operation and urine glucose and sodium concentrations. Statistical significance within the group: Friedmann Test, between the groups: U test by Wilcoxon, Mann and Witney.
Significance:
p < 0.05. RESULTS (given as median and range): In group I blood glucose concentrations rose significantly during surgery, however, there was no significant difference between group A or B after 1 h. A: 234 mg/dl (156-351) vs B: 239 mg/dl (166-329)) or 2 h: A: 254 mg/dl (166-331) vs B: 272 mg/dl (176-468). In group II blood glucose levels rose significantly during surgery, however, children of group B showed significantly higher blood glucose levels than group A after 1 h [A: 119 mg/dl (114-227), B: 203 mg/dl (162-238)], 2 h [A: 154 mg/ml (106-185), B: 284 mg/dl (243-317)] or 3 h [A: 159 mg/dl (116-218), B: 248 mg/dl (201-363)]. The plasma and urine sodium concentrations did statistically not differ between the two solutions.
Conclusions:
Solutions containing 5.5% glucose infused with 8 ml/kg/h caused in both age groups of infants intolerable hyperglycemias. In young infants, also a solution containing 2.5% glucose infused at a rate of 8 ml/kg/h leads to hyperglycemia, while in older children this amount of glucose is tolerated. It is recommended that for abdominal surgery in young infants glucose and fluid substitution is separated, in order to infuse glucose at an even lower rate. Still, blood glucose levels have to be monitored closely.