Continuous monitoring of blood glucose concentration was compared with frequent intermittent sampling in 12 non-diabetic adult patients undergoing open-heart surgery with cardiopulmonary by-pass using priming fluids free of glucose. Continuous monitoring revealed several changes which were not detected on intermittent sampling. Blood glucose concentration decreased by 2 mmol litre-1 +/- 0.5 (SEM) (P less than 0.01) immediately on the institution of CPB, and increased during the succeeding minutes. Rewarming from hypothermic by-pass was associated with a 3 (+/- 0.5)-mmol litre-1 increase in blood glucose concentration (P less than 0.01). Commencement of infusions of sympathomimetic agents resulted in a similar increase.

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Different crystalloid cardiopulmonary bypass pump-priming fluids provide very different substrate loads to patients undergoing open-heart surgery. As a result they may modulate the endocrine milieu, and thus might be expected to alter postoperative nitrogen balance. To test this hypothesis, 24 adult patients undergoing open-heart valve surgery were randomized into four matched groups each to receive a different prime, namely: Hartmann's solution, Plasmalyte 148R, Solution 11 R and a prime consisting of equal volumes of Hartmann's solution and 5% dextrose. Accurate nitrogen balance studies were obtained each 24 hours from one day preoperatively to seven days postoperatively. The results obtained demonstrated that postoperative nitrogen balance was unaffected by the nature of the crystalloid pump prime. Nitrogen balance in the patients studied was better than that reported from other centres in similar patients.

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