Perioperative management of total parenteral nutrition glucose containing solutions, and intraoperative glucose monitoring in paediatric patients: a survey of clinical practice

Infants and children, particularly those who are chronically ill and mainta ined on total parenteral nutrition (TPN), are at risk for perioperative hyp oglycaemia [blood glucose < 2.2 mmol.l(-1) (40 mg.dl(-1))] and hyperglycaem ia [blood glucose > 11 mmol.l(-1) (200 mg.dl(-1))]. We surveyed paediatric anaesthesiologists regarding their perioperative management of blood glucos e and TPN in paediatric patients to determine the current practice and its perceived success. Questionnaires were mailed to all members of the Study G roup on Pediatric Anesthesia and the response rate was 70%. Results indicat e that the current perioperative management of blood glucose and TPN is som ewhat varied. Furthermore, greater than 10% of those surveyed report that t heir management results in a variable response in the maintenance of normog lycaemia. While the detrimental effects of perioperative hypoglycaemia and hyperglycaemia are rare, they are serious. A Medline search shows that no s tudies have been published regarding perioperative management of paediatric patients receiving TPN, although it appears that clinical study is warrant ed.