Metabolic consequences of different perioperative fluid therapies in the neonatal period.
Carbohydrate and fat metabolism during and after anaesthesia and surgery was studied in 14 neonates with major congenital non-cardiac anomalies. They were either given a glucose solution until surgery or starved for at least 4 h before surgery. Ringer-acetate alone or Ringer-acetate plus 10% glucose was used for the intraoperative fluid therapy. After anaesthesia all neonates were given a 10% glucose solution. Concentrations of glucose, free fatty acids, triglycerides, lactate, pyruvate, alanine, glycerol and 3-hydroxybutyrate were measured at predetermined intervals pre-, intra- and postoperatively. Blood glucose concentrations rose during surgery both in neonates given glucose before and during surgery (n = 6) and in neonates not given glucose before and during surgery (n = 6). Increased intraoperative levels of free fatty acids and 3-hydroxybutyrate were found in neonates not given glucose before and during surgery. The triglyceride levels were equal in both groups. In two neonates given glucose before surgery and Ringer-acetate during surgery increased levels of 3-hydroxybutyrate were found, particularly in one patient who became hypoglycaemic. In conclusion, starved neonates without intraoperative glucose supply mobilized fat and maintained blood glucose concentrations.
Sandström
K
K
Department of Paediatric Anaesthesia and Intensive Care, Ostra Hospital, Gothenburg, Sweden.
Nilsson
K
K
Andréasson
S
S
Niklasson
A
A
Larsson
L E
LE
D020155:3-Hydroxybutyric Acid; D000409:Alanine / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D004734:Energy Metabolism; D005215:Fasting; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005440:Fluid Therapy; D005943:Gluconeogenesis; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D005990:Glycerol / Q000097:blood; D006706:Homeostasis; D006801:Humans; D006885:Hydroxybutyrates / Q000097:blood; D007231:Infant, Newborn / Q000097:blood / Q000378:metabolism*; D007262:Infusions, Intravenous; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D007773:Lactates / Q000097:blood; D050356:Lipid Metabolism; D008055:Lipids / Q000097:blood; D011300:Preoperative Care; D011773:Pyruvates / Q000097:blood; D013514:Surgical Procedures, Operative; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D006885:Hydroxybutyrates; D007552:Isotonic Solutions; D007773:Lactates; D008055:Lipids; D011773:Pyruvates; C028570:Ringer's acetate; D014280:Triglycerides; D005947:Glucose; D000409:Alanine; D005990:Glycerol; D020155:3-Hydroxybutyric Acid