Comparison of two solutions with different glucose concentrations for infusion therapy during laparotomies in infants.

Abstract

Objective: Comparison of two commercially available solutions for intraoperative infusion therapy during laparotomies in infants using a standardized anesthetic technique (combination of general anesthesia with a caudal block).

Design: Prospective, randomized.

Setting: Infusion therapy during laparotomies in infants.

Patients and methods: 12 infants aged 1-12 weeks (group I) and 12 infants aged 5-14 months (group II) received at random either solution A with 2.5% glucose and 70 mmol Na+ or solution B with 5.5% glucose and 100 mmol Na+ at a rate of 8 ml/kg/h.

Interventions: Central venous blood samples after induction of anesthesia and every 60 min for analysis of blood glucose, electrolyte, and hemoglobin concentrations. End of surgery: urine output during the operation and urine glucose and sodium concentrations. Statistical significance within the group: Friedmann Test, between the groups: U test by Wilcoxon, Mann and Witney.

Significance: p < 0.05. RESULTS (given as median and range): In group I blood glucose concentrations rose significantly during surgery, however, there was no significant difference between group A or B after 1 h. A: 234 mg/dl (156-351) vs B: 239 mg/dl (166-329)) or 2 h: A: 254 mg/dl (166-331) vs B: 272 mg/dl (176-468). In group II blood glucose levels rose significantly during surgery, however, children of group B showed significantly higher blood glucose levels than group A after 1 h [A: 119 mg/dl (114-227), B: 203 mg/dl (162-238)], 2 h [A: 154 mg/ml (106-185), B: 284 mg/dl (243-317)] or 3 h [A: 159 mg/dl (116-218), B: 248 mg/dl (201-363)]. The plasma and urine sodium concentrations did statistically not differ between the two solutions.

Conclusions: Solutions containing 5.5% glucose infused with 8 ml/kg/h caused in both age groups of infants intolerable hyperglycemias. In young infants, also a solution containing 2.5% glucose infused at a rate of 8 ml/kg/h leads to hyperglycemia, while in older children this amount of glucose is tolerated. It is recommended that for abdominal surgery in young infants glucose and fluid substitution is separated, in order to infuse glucose at an even lower rate. Still, blood glucose levels have to be monitored closely.