Glucose and insulin changes in infants and children undergoing hypothermic open-heart surgery

Benzing, George; Francis, Paul; Kaplan, Samuel; Helmsworth, James A.; Sperling, Mark A.

doi:10.1016/0002-9149(83)90083-8

Cited by 45 publications

(26 citation statements)

References 25 publications

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“…High blood glucose levels at the end of CPB surgery for congenital heart defects also were found in previous studies [1, 7, 21, 24]. We found a spontaneous normalization of blood glucose levels within 24 h postoperatively, which is in line with the finding of one other study [24].…”

Section: Discussionsupporting

confidence: 92%

“…Preissig and Rigby [20] hypothesized that beta cells, known to be exquisitely sensitive to rapid physiologic changes, may become dysfunctional if these changes occur acutely above a certain threshold. These changes may be induced by multiple factors such as hypothermia, vasopressors, elevations of proinflammatory cytokines, and use of glucocorticoids [1, 9, 12, 20]. …”

Section: Discussionmentioning

confidence: 99%

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Disturbance of Glucose Homeostasis After Pediatric Cardiac Surgery

et al. 2010

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This study aimed to evaluate the time course of perioperative blood glucose levels of children undergoing cardiac surgery for congenital heart disease in relation to endogenous stress hormones, inflammatory mediators, and exogenous factors such as caloric intake and glucocorticoid use. The study prospectively included 49 children undergoing cardiac surgery. Blood glucose levels, hormonal alterations, and inflammatory responses were investigated before and at the end of surgery, then 12 and 24 h afterward. In general, blood glucose levels were highest at the end of surgery. Hyperglycemia, defined as a glucose level higher than 8.3 mmol/l (>150 mg/dl) was present in 52% of the children at the end of surgery. Spontaneous normalization of blood glucose occurred in 94% of the children within 24 h. During surgery, glucocorticoids were administered to 65% of the children, and this was the main factor associated with hyperglycemia at the end of surgery (determined by univariate analysis of variance). Hyperglycemia disappeared spontaneously without insulin therapy after 12–24 h for the majority of the children. Postoperative morbidity was low in the study group, so the presumed positive effects of glucocorticoids seemed to outweigh the adverse effects of iatrogenic hyperglycemia.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Disturbance of Glucose Homeostasis After Pediatric Cardiac Surgery

et al. 2010

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“…In addition, there may be other unmeasured factors impacting glucose levels and in turn, use of insulin, in the post-operative period. Among these factors are duration of cardiopulmonary bypass and the use of deep hypothermic circulatory arrest (40,41). Finally, the accuracy of coding of congenital heart surgery in administrative datasets is not known.…”

Section: Discussionmentioning

confidence: 99%

Corticosteroids and Outcome in Children Undergoing Congenital Heart Surgery

et al. 2010

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Background-Children undergoing congenital heart surgery often receive corticosteroids with the aim of reducing the inflammatory response after cardiopulmonary bypass; however, the value of this approach is unclear. Corticosteroids were associated with longer length of stay (least square mean difference, 2.18 days; 95% confidence interval, 1.62 to 2.74 days), greater infection (odds ratio, 1.27; 95% confidence interval, 1.10 to 1.46), and greater use of insulin (odds ratio, 2.45; 95% confidence interval, 2.24 to 2.67). There was no difference in duration of ventilation. In analysis stratified by RACHS-1 category, no significant benefit was seen in any group, and the association of corticosteroids with increased morbidity was most prominent in RACHS-1 categories 1 through 3. Conclusion-In this observational analysis of children undergoing congenital heart surgery, we were unable to demonstrate a significant benefit associated with corticosteroids and found that corticosteroids may be associated with increased morbidity, particularly in lower-risk patients. (Circulation. 2010;122:2123-2130.) Methods and Results-The

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“…Profound hypothermia and total circulatory arrest, which has been employed in the majority of centers in the first stage of Norwood operation, have effects in the relationship between oxygen delivery and consumption. Moreover, the metabolic response to stress is more pronounced in children 15 . Oxygen consumption is independent of oxygen delivery in a wide range of situations.…”

Section: Introductionmentioning

confidence: 97%

Fisiologia aplicada ao tratamento atual do recém-nascido com síndrome de hipoplasia do coração esquerdo

Atik¹

2006

Arq. Bras. Cardiol.

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Glucose and insulin changes in infants and children undergoing hypothermic open-heart surgery

Cited by 45 publications

References 25 publications

Disturbance of Glucose Homeostasis After Pediatric Cardiac Surgery

Disturbance of Glucose Homeostasis After Pediatric Cardiac Surgery

Corticosteroids and Outcome in Children Undergoing Congenital Heart Surgery

Fisiologia aplicada ao tratamento atual do recém-nascido com síndrome de hipoplasia do coração esquerdo

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