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. 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 in = 20) received 546 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 (T-0), before CPB (T-1), 10 minutes after initiation of CPB (T-2), 10 minutes after initiation of rewarming (T-3) and at the end of the procedures (T-4) Postoperatively, blood glucose was measured at the first, 12th, and 24th hours. Measurements and Results: During the prebypass 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 smalt 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 prebypass period, and moderate intraoperative glucose administration (2.5 mg/kg/min) is not responsible for major hyperglycemia. Copyright (C) 1997 by W.B. Saunders Company.