Effect of intraoperative fluid on blood glucose level in neurosurgery

There is a considerable controversy regarding glucose administration during intracranial surgery. However, recent animal and human studies suggest that hyperglycemia exacerbates ischemic brain damage and intraoperative hypoglycemia may not be a concern if the surgical procedure is less than 4 hours. We, therefore, studied the blood glucose in neurosurgery with craniotomy in 90 Thai patients, divided into 3 groups. 30 patients in each group received balanced salt solution (0.9% NSS), 5 per cent glucose rate 60-80 ml/h and 5 per cent glucose rate more than 120 ml/h. Blood for the determination of glucose concentration was obtained after induction and every 2 hours later until the end of the surgery. There was one male patient in group I who received balanced salt solution (0.9% NSS) had blood glucose concentration lowered to 57 mg% at 4 hours after induction. The patients in group II who received 5 per cent glucose solution at maintenance rate did not have hyperglycemia (161.20 +/- 38.30 mg%). In group III; patients given 5 per cent glucose infusion at the rate of more than 120 ml/h had hyperglycemia (236.75 +/- 63.57 mg%) at 6 hours. In conclusion, we suggest that in Thai patients undergoing neurosurgical procedures; blood glucose levels should be checked intraoperatively if glucose is withheld from the intraoperative fluid regimen. Otherwise 80 ml/h of 5 per cent dextrose intravenous infusion should be given to the patients to prevent hypoglycemia.