Impact of dextrose supplementation on intraoperative blood glucose levels in pediatric patients undergoing major surgeries under general anesthesia with caudal analgesia.

Abstract

Background and aims: In children undergoing surgery, the stress responses of surgery can result in blood glucose elevation consequent to release of cortisol and catecholamines. The use of a regional block could attenuate the stress responses and lower the blood glucose levels. We compared the blood glucose values at specified time points during surgery with and without additional dextrose to evaluate the need for glucose supplementation as our primary outcome. Intraoperative hemodynamics and the need for any intervention for correction of blood sugars were noted secondarily.

Material and methods: Children aged between 6 months and 8 years undergoing elective major surgery were randomized to group D (received 1% dextrose in Ringer's lactate) or group P (received only Ringer's lactate). Blood sugars were measured half hourly for 2 h following intubation, and data was analyzed using Student's t-test and Chi-square test.

Results: Demographic variables and the duration of surgery were comparable. The baseline blood glucose value was lower in group D. Analysis of covariates test for a comparison of adjusted mean blood glucose (MBG) showed the values at 30, 60, and 90 min to be comparable. However, toward the end of surgery, the MBG value was significantly higher in group D (P = 0.019). Heart rate and mean arterial pressure were comparable at the same points of measurement.

Conclusion: Dextrose supplementation is not needed for children receiving caudal analgesia for major surgeries of 2-3 h duration and may raise blood sugars at the end of surgery.