The effect of intravenous dextrose infusion on postbypass hyperglycemia in pediatric patients undergoing cardiac operations.

STUDY OBJECTIVE

To determine whether elimination of intraoperative dextrose-containing infusions affects post-cardiopulmonary bypass hyperglycemia in pediatric patients.

DESIGN

Randomized, unblinded, saline-controlled study of perioperative glucose infusions in children undergoing cardiac surgery.

SETTING

Cardiac surgery suite and pediatric intensive care unit (ICU) of a university medical center.

PATIENTS

33 consecutive, nondiabetic children undergoing cardiac surgery with deep hypothermia over an 8-month period.

INTERVENTIONS

Group A (n = 16) received only normal saline infusions intraoperatively, and Group B (n = 17) received 5% dextrose and lactated Ringer's solution exclusively. Blood glucose was sampled immediately after induction of anesthesia, prior to cardiopulmonary bypass (CPB), after separation from CPB, on arrival in the ICU, and the morning of the first postoperative day. Data were analyzed using Student's t-test for independent samples, paired t-test, and analysis of variance, with p < 0.05 considered significant.

MEASUREMENTS AND MAIN RESULTS

Although moderate elevations in blood glucose (mean less than 165 mg/dl) after CPB were present in Group A, significantly higher levels (mean greater than 250 mg/dl) were noted in Group B. No children were hypoglycemic (glucose less than 40 mg/dl). Glucose levels were normal in both groups on the morning of the first postoperative day despite patients' having received continuous dextrose infusions in the ICU and the presumed stress of emergence from anesthesia.

CONCLUSIONS

Extreme postbypass hyperglycemia can be controlled by eliminating intraoperative dextrose infusions. Hypoglycemia, an unlikely event, can easily be avoided by regular blood sampling, which is facilitated by the routine placement of arterial catheters.