GLUCOSE VERSUS LACTATED RINGERS SOLUTION DURING PEDIATRIC CARDIAC-SURGERY

Objective: Whether intraoperative fluid infusion should contain glucos e during pediatric cardiac surgery remains controversial. This study w as performed to compare the effects of glucose and glucose-free soluti ons on blood glucose and blood insulin levels during total repair of c ongenital heart diseases. Design: Prospective randomized and blinded s tudy. Setting: Cardiovascular university center. Participants: Forty n ondiabetic children, weight ranging from 4 to 10 kg, scheduled for car diac surgical procedures requiring cardiopulmonary bypass (CPB) withou t total circulatory arrest. Interventions: Group R (n = 20) was admini stered lactated Ringer's solution intraoperatively, and group G in = 2 0) received 546 glucose. Fluids were infused at a rate of 3 mL/kg/h in the two groups from the induction of anesthesia to the end of the sur gical procedure. Blood glucose and insulin were sampled before infusio n (T-0), before CPB (T-1), 10 minutes after initiation of CPB (T-2), 1 0 minutes after initiation of rewarming (T-3) and at the end of the pr ocedures (T-4) Postoperatively, blood glucose was measured at the firs t, 12th, and 24th hours. Measurements and Results: During the prebypas s period, three children in group R had severe hypoglycemia (blood glu cose < 40 mg/dL). After initiation of CPB, blood glucose increased in both groups, with a smalt difference at the end of the procedure. No i nfants in the two groups had blood glucose higher than 239 mg/dL. Conc lusions: Glucose withdrawal during pediatric cardiac surgery induces t hreatening hypoglycemia during the prebypass period, and moderate intr aoperative glucose administration (2.5 mg/kg/min) is not responsible f or major hyperglycemia. Copyright (C) 1997 by W.B. Saunders Company.