title: Intraoperative glycemic control without insulin infusion during pediatric cardiac surgery for congenital heart disease.
abstract: BACKGROUND
  Many studies are reporting that the occurrence of hyperglycemia in the postoperative period is associated with increased morbidity and mortality rates in children after cardiac surgery for congenital heart disease. This study sought to determine blood glucose levels in standard pediatric cardiac anesthesiological management without insulin infusions.
  
  
  METHODS
  The study population consisted of 204 consecutive pediatric patients aged from 3 days to 15.4 years undergoing open cardiac surgery for congenital heart disease between June 2007 and January 2009. Glucose-containing fluids were not administrated intraoperatively, and all patients received high dose of opioids (sufentanil 10 mcg·kg(-1) ) and steroids (30 mg·kg(-1) methylprednisolone) iv. Glucose levels were measured before CPB, 10 min after initiation of CPB, every hour on CPB, post-CPB, and on arrival at intensive care unit (ICU).
  
  
  RESULTS
  Intraoperatively, only one patient had a glucose level <50 mg·dl(-1) (=34.2 mg·dl(-1) ), 57/204 patients (27.9%) had at least one intraoperative glucose >180 mg·dl(-1) , but only 12 patients (5.8%) had a glucose level >180 mg·dl(-1) at ICU arrival. Thirty-day mortality was 1.5% (3/204). Younger age, lower body weight, and lower CPB temperature were associated with hyperglycemia at ICU arrival, as were higher RACHS and Aristotle severity scores.
  
  
  CONCLUSIONS
  A conventional (no insulin, no glucose) anesthetic management seems sufficient in the vast majority of patients (96.5%). Special attention should be paid to small neonates with complex congenital heart surgery, in whom insulin treatment may be contemplated.
authors.affiliation: Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands. t.scohy@erasmusmc.nl
authors.forename: Thierry V
authors.initials: TV
authors.lastname: Scohy
authors.forename: Hanna D
authors.initials: HD
authors.lastname: Golab
authors.forename: Mohamud
authors.initials: M
authors.lastname: Egal
authors.forename: Johanna J M
authors.initials: JJ
authors.lastname: Takkenberg
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
mesh_terms: D000293:Adolescent; D018686:Anesthetics, Intravenous; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism*; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D006324:Heart Arrest, Induced; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D006943:Hyperglycemia / Q000628:therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007036:Hypothermia, Induced; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010952:Plasma Substitutes; D011229:Preanesthetic Medication; D011300:Preoperative Care; D018570:Risk Assessment; D017409:Sufentanil
chemical_list: D018686:Anesthetics, Intravenous; D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D010952:Plasma Substitutes; D017409:Sufentanil; D008775:Methylprednisolone