Glucose versus lactated Ringer's solution during pediatric cardiac surgery.

ABSTRACT

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. DESIGN: Prospective randomized and blinded study. SETTING: Cardiovascular university center. PARTICIPANTS: Forty nondiabetic children, weight ranging from 4 to 10 kg, scheduled for cardiac surgical procedures requiring cardiopulmonary bypass (CPB) without total circulatory arrest. INTERVENTIONS: 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. MEASUREMENTS AND 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.