Intraoperative blood glucose levels in nondiabetic patients undergoing elective major surgery under general anaesthesia receiving different crystalloid solutions for maintenance fluid

Souvik Maitra, Jyotirmay Kirtania, Samaendra Pal, Sulagna Bhattacharjee, Amitava Layek, Shreyasi Ray, Souvik Maitra, Jyotirmay Kirtania, Samaendra Pal, Sulagna Bhattacharjee, Amitava Layek, Shreyasi Ray

Abstract

Context: The study was undertaken to observe the effect of different maintenance-fluid regimen on intraoperative blood glucose levels in non-diabetic patients undergoing elective major non-cardiac surgery under general anesthesia.

Aims: To know the intraoperative blood glucose levels.

Settings and design: Prospective randomized parallel group study.

Subjects and methods: Two hundred non-diabetic patients (100 in each group) aged between 18 years and 60 years were enrolled for this prospective randomized parallel group study. Group A patients received Ringer's lactate solution and Group B patients received 0.45% sodium chloride with 5% dextrose and 20 mmol/L potassium chloride as maintenance fluid. Capillary blood glucose (CBG) level was measured immediately before initiation of intravenous fluid therapy and thereafter hourly till the end of surgery. If at any time intraoperative CBG was found to be more than or equal to 150 mg/dL calculated dose of human soluble insulin was given as intravenous bolus equal to the amount of CBG/100 units.

Statistical analysis used: For comparison of normally distributed variables independent sample t test was done. For rest of the data, i.e., CBG_0, CBG_4 and insulin consumption Mann-Whitney U test was employed.

Results: 63% patients in group B developed at least one episode of hyperglycemia CBG ≥ 150 mg/dL) but only 29% in the Group A did so. Insulin consumption was significantly higher in Group B than in Group A to maintain normoglycemia. The relative risk of becoming hyperglycemic in Group B patients is 2.172 (95% CI 1.544 to 3.057). Number needed to harm, i.e., hyperglycemia, in Group B is 2.941 (95% CI 2 to 5).

Conclusions: We conclude that stress induced-hyperglycemic response in patients undergoing major non-cardiac surgery is common in non-diabetic population. Maintenance-fluid therapy by dextrose containing solution as opposed to Ringer's lactate solution increases the incidence of hyperglycemia. To achieve normoglycemia by intravenous bolus dose of human regular insulin, significantly higher doses are required in patients receiving dextrose containing saline as maintenance fluid.

Keywords: Intraoperative hyperglycemia; maintenance fluid; non-diabetic patients.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Distribution of capillary blood glucose_1, capillary blood glucose_2, capillary blood glucose_3, capillary blood glucose_4 and capillary blood glucose_5 respectively in two groups
Figure 2
Figure 2
Comparison of insulin consumption between two groups
Figure 3
Figure 3
Incidence of hyperglycemic episodes in each group

References

    1. Barton RN. The neuroendocrinology of physical injury. Baillieres Clin Endocrinol Metab. 1987;1:355–74.
    1. Desborough JP, Hall GM. Endocrine response to surgery. In: Kaufman L, editor. Anaesthesia Review. Vol. 10. Edinburg: Churchill Livingstone; 1993. pp. 131–48.
    1. Thorell A, Efendic S, Gutniak M, Häggmark T, Ljungqvist O. Development of postoperative insulin resistance is associated with the magnitude of operation. Eur J Surg. 1993;159:593–9.
    1. Kaye Alan D, Riopelle James M. Intravascular Fluid and Electrolyte Physiology. In: Miller RD, editor. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010. pp. 1728–9.
    1. Obata K, Ogata M, Matsumoto T, Takenaka I, Sata T, Shigematsu A. The effects of glucose on plasma amino acids and pyruvate during upper abdominal surgery. Anesth Analg. 1993;76:357–61.
    1. Larsson LE, Nilsson K, Niklasson A, Andreasson S, Ekström-Jodal B. Influence of fluid regimens on perioperative blood-glucose concentrations in neonates. Br J Anaesth. 1990;64:419–24.
    1. Dave N, Khan MA, Halbe AR, Kadam PP, Oak SN, Parelkar SV. A study of blood glucose in paediatric laparoscopy. Acta Anaesthesiol Scand. 2007;51:1350–3.
    1. Bower WF, Lee PY, Kong AP, Jiang JY, Underwood MJ, Chan JC, et al. Peri-operative hyperglycemia: A consideration for general surgery? Am J Surg. 2010;199:240–8.
    1. Smiley DD, Umpierrez GE. Perioperative glucose control in the diabetic or nondiabetic patient. South Med J. 2006;99:580–9.
    1. Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125:1007–21.
    1. Walsh ES, Traynor C, Paterson JL, Hall GM. Effect of different intraoperative fluid regimens on circulating metabolites and insulin during abdominal surgery. Br J Anaesth. 1983;55:135–40.
    1. Chin KJ, Macachor J, Ong KC, Ong BC. A comparison of 5% dextrose in 0.9% normal saline versus non-dextrose-containing crystalloids as the initial intravenous replacement fluid in elective surgery. Anaesth Intensive Care. 2006;34:613–7.
    1. Azarfarin R, Alizadeh Asl A. Prevalence and intensity of hyperglycemia in non-diabetic patients undergoing coronary artery bypass graft surgery with and without cardiopulmonary bypass. Saudi Med J. 2008;29:1294–8.
    1. Saringcarinkul A, Kotrawera K. Plasma glucose level in elective surgical patients administered with 5% dextrose in 0.45% NaCl in comparison with those receiving lactated Ringer's solution. J Med Assoc Thai. 2009;92:1178–83.
    1. Smith CE, Styn NR, Kalhan S, Pinchak AC, Gill IS, Kramer RP, et al. Intraoperative glucose control in diabetic and nondiabetic patients during cardiac surgery. J Cardiothorac Vasc Anesth. 2005;19:201–8.
    1. Prasad AA, Kline SM, Schuler HG, Sukernik MR. Clinical and laboratory correlates of excessive and persistent blood glucose elevation during cardiac surgery in nondiabetic patients: A retrospective study. J Cardiothorac Vasc Anesth. 2007;21:843–6.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren