Impact of different intravenous fluids on blood glucose levels in nondiabetic patients undergoing elective major noncardiac surgeries

Abstract

Background:Intravenous (IV) fluids are an integral part of perioperative management. Intraoperative hyperglycemia is associated with poor clinical outcomes in patients undergoing major surgeries even in nondiabetics.Aim:This study was conducted to observe the effect of different maintenance fluid regimens on intraoperative blood glucose levels in nondiabetic patients undergoing major surgeries under general anesthesia.Settings and Design:Randomized double-blind study.Materials and Methods:One hundred nondiabetic patients of either sex were divided randomly into two Groups I and II of 50 each undergoing elective major surgeries of more than 90 min duration under general anesthesia. Both groups were given calculated dosage of IV fluids accordingly 4-2-1 formula while Group I was given Ringer lactate (RL) and Group II was given 0.45% dextrose normal saline and potassium chloride 20 mmol/L. Changes in vital parameters, % oxygen saturation, and urine output were monitored at regular intervals. Capillary blood glucose (CBG) was measured half-hourly until end of surgery. If CBG level was more than 150 mg%, then calculated dose of human insulin (CBG/100) was given as IV bolus dose.Statistical Analysis:Statistical analysis was done using SPSS 22.0 software (IBM Corporation, Armonk, New York, USA), paired t-test and Chi-square test.Results:A significant increase of CBG level and was observed during intraoperative and immediate postoperative period (P < 0.001) in Group II.Conclusion:RL solution is probably the alternative choice of IV fluid for perioperative maintenance and can be used as replacement fluid in nondiabetic patients undergoing major surgeries.

Effect of 0.9% saline and Ringer’s lactate on mean change in blood glucose levels under spinal anaesthesia among diabetic patients

“…fluid for replacement and perioperative maintenance in nondiabetic patients undergoing major surgeries. 10 Thus, absence of sound theoretical basis and paucity of supporting clinical trials, do not justify the practice of avoiding lactate-containing i.v. fluids in diabetic patients.…”

“…12 Thus, regional anaesthesia techniques like local infiltration, nerve/ plexus blocks, spinal and epidural anaesthesia can block the surgical stress response and mitigate the perioperative hyperglycaemia. 5,10 Risk of infection, vascular injury and an exaggerated sympatholytic response in patients with autonomic neuropathies are some of the concerns with regional anaesthesia in diabetic patients. 13 In the present study, patients receiving only spinal anaesthesia were selected to avoid selection bias and as such the findings may be different in patients receiving other types of anaesthesia and needs further investigation.…”

Managing Patients Undergoing Orthopedic Surgery to Improve Glycemic Outcomes

“…Recent data does not support the suggested hyperglycemic effects of lactated Ringer’s in persons with diabetes undergoing surgery [ 47 , 48 ]. Initiation of dextrose containing IV fluid is not required to prevent hypoglycemia in elective surgery and can lead to transient hyperglycemia [ 49 ]. In cases of severe hyperglycemia with metabolic acidosis, large volumes of normal saline infusion can worsen metabolic acidosis by increasing chloride and decreasing bicarbonate, whereas the sodium lactate in lactated ringers serves as a buffer [ 50 ].…”

Quantitative Investigation into the influence of intravenous fluids on human immune and cancer cell lines

“…This technique involves the application of intravenous fluids (IVF). The first usage of IVF dates to the 1830s when Shaughnessy used intravenous salt solutions to treat cholera 2 , 3 . Since then, IVF, have been utilized in clinical practice on a large scale through intravenously injections to patients 4 .…”

“…Jackson and Derleth examined the effect of brief contact with various infusion solutions on red blood cells from 1 Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, 34956, Turkey. 2 Sabanci University Nanotechnology and Application Center, Sabanci University, Istanbul, 34956, Turkey. ✉ e-mail: melitas@sabanciuniv.edu open www.nature.com/scientificreports www.nature.com/scientificreports/ newborn infants.…”