THE EFFECT OF INTRAVENOUS DEXTROSE INFUSION ON POSTBYPASS HYPERGLYCEMIA IN PEDIATRIC-PATIENTS UNDERGOING CARDIAC OPERATIONS

Study Objective: To determine whether elimination of intraoperative de xtrose-containing infusions affects post-cardiopulmonary bypass hyperg lycemia in pediatric patients. Design: Randomized, unblinded, saline-c ontrolled study of perioperative glucose infusions in children undergo ing cardiac surgery. Setting: Cardiac surgery suite and pediatric inte nsive care unit (ICU) of a university medical center. Patients: 33 con secutive, nondiabetic children undergoing cardiac surgery with deep hy pothermia over an 8-month period. Interventions: Group A (n = 16) rece ived only normal saline infusions intraoperatively, and Group B (n = 1 7) received 5% dextrose and lactated Ringer's solution exclusively. Bl ood glucose was sampled immediately after induction of anesthesia, pri or to cardiopulmonary bypass (CPB), after separation from CPB, on arri val in the ICU, and the morning of the first postoperative day. Data w ere 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 g lucose (mean less than 165 mg/dl) after CPB were present in Group A si gnificantly higher levels (mean greater than 250 mg/dl) were noted in Group B. No children were hypoglycemic (glucose less than 40 mg/dl). G lucose levels were normal in both groups on the morning of the first p ostoperative day despite patients' having received continuous dextrose infusions in the ICU and the presumed stress of emergence from anesth esia. Conclusions: Extreme postbypass hyperglycemia can be controlled by eliminating intraoperative dextrose infusions. Hypoglycemia, an unl ikely event, can easily be avoided by regular blood sampling, which is facilitated by the routine placement of arterial catheters.