Glucose versus lactated Ringer's solution during pediatric cardiac surgery.
OBJECTIVE
Whether intraoperative fluid infusion should contain glucose during pediatric cardiac surgery remains controversial. This study was performed to compare the effects of glucose and glucose-free solutions on blood glucose and blood insulin levels during total repair of congenital heart diseases.


METHODS
Prospective randomized and blinded study.


METHODS
Cardiovascular university center.


METHODS
Forty nondiabetic children, weight ranging from 4 to 10 kg, scheduled for cardiac surgical procedures requiring cardiopulmonary bypass (CPB) without total circulatory arrest.


METHODS
Group R (n = 20) was administered lactated Ringer's solution intraoperatively, and group G (n = 20) received 5% 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 surgical procedure. Blood glucose and insulin were sampled before infusion (Tzero), before CPB (T1), 10 minutes after initiation of CPB (T2), 10 minutes after initiation of rewarming (T2), and at the end of the procedures (T4). Postoperatively, blood glucose was measured at the first, 12th, and 24th hours.


RESULTS
During the prabypass period, three children in group R had severe hypoglycemia (blood glucose < 40 mg/dL). After initiation of CPB, blood glucose increased in both groups, with a small difference at the end of the procedure. No infants in the two groups had blood glucose higher than 239 mg/dL.


CONCLUSIONS
Glucose withdrawal during pediatric cardiac surgery induces threatening hypoglycemia during the prabypass period, and moderate intraoperative glucose administration (2.5 mg/kg/min) is not responsible for major hyperglycemia.
Aouifi
A
A
Service d'Anesthésie-Réanimation Chirurgicale, Hopital Cardiovasculaire et Pneumologique L Pradel, Lyon, France.
Neidecker
J
J
Vedrinne
C
C
Bompard
D
D
Cherfa
A
A
Laroux
M C
MC
Brulé
P
P
Champsaur
G
G
Lehot
J J
JJ
D000762:Anesthesia Recovery Period; D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D006324:Heart Arrest, Induced; D006330:Heart Defects, Congenital / Q000601:surgery; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000209:etiology; D007223:Infant; D007262:Infusions, Intravenous; D007328:Insulin / Q000097:blood; D007430:Intraoperative Care; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D000077325:Ringer's Lactate; D016037:Single-Blind Method; D013927:Thrombosis / Q000209:etiology
D001786:Blood Glucose; D007328:Insulin; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D005947:Glucose