Intraoperative glycemic control without insulin infusion during pediatric cardiac surgery for congenital heart disease.

Thierry V Scohy (1) , Hanna D Golab (2) , Mohamud Egal (3) , Johanna J.M. Takkenberg (2) , Ad J.J.C. Bogers (2)

1 Anesthesiology
2 Cardiothoracic surgery
3 Anesthesiology

Background: Many studies are reporting that the occurrence of hyperglycemia in the postoperative period is associated with increased morbidity and mortality rates in children after cardiac surgery for congenital heart disease. The study sought to determine blood glucose levels in standard pediatric cardiac anesthesiological management without insulin infusions. Methods: The study population consisted of 204 consecutive pediatric patients aged from 3 days to 15.4 years undergoing open cardiac surgery for congenital heart disease between June 2007 and January 2009. Glucose containing fluids were not administrated intraoperatively, all patients received high dose of opioids (sufentanil 10mcg/kg) and steroids (30mg/kg methylprednisolone) iv. Glucose levels were measured before CPB, 10 minutes after initiation of CPB, every hour on CPB, post CPB and on arrival at Intensive Care Unit (ICU). Results: Intraoperatively only 1 patient had a glucose level < 50 mg/dl (=34.2 mg/dl), 57/204 patients (27.9%) had at least one intraoperative glucose > 180 mg/dl, but only 12 patients (5.8%) had a glucose level > 180 mg/dl at ICU arrival. 30 days mortality was 1.5% (3/204). Younger age, lower body weight and lower CPB temperature were associated with hyperglycemia at ICU arrival, as were higher RACHS and Aristotle severity scores. Conclusion: A conventional (no insulin, no glucose) anesthetic management seems sufficient in the vast majority of patients (96.5%). Special attention should be paid to small neonates with complex congenital heart surgery, in whom insulin treatment may be contemplated

Mots clés: Medicine

Thierry V Scohy, Hanna D Golab, Mohamud Egal, Johanna J.M. Takkenberg, Ad J.J.C. Bogers. Intraoperative glycemic control without insulin infusion during pediatric cardiac surgery for congenital heart disease.. Pediatric Anesthesia, 2011, 21 (8), pp.872. ⟨10.1111/j.1460-9592.2011.03571.x⟩. ⟨hal-00628685⟩