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

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.

Evaluation of the metabolic profile of ringer lactate versus ringer acetate in nondiabetic patients undergoing major surgeries

“…[ 6 ] These results were similar to the previous study done by Maitra et al . [ 7 ] which showed that maintenance fluid therapy with dextrose-containing solution resulted in a higher incidence of hyperglycemia when compared to Ringer's Lactate. The choice of fluids along with the type of surgery the patient undergoes influences the blood glucose level in this subset of patients.…”

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

“…A prospective, randomized, parallel study was conducted in 2013 by Maitra et al . [ 11 ] on 200 nondiabetic patients to study intraoperative blood glucose levels in patients undergoing elective major surgery receiving different crystalloid solutions, as maintenance fluids. It was found that CBG levels increased with progression of surgery and mean CBG values at 1 st , 2 nd , and 3 rd h were significantly higher in patients receiving 0.45% sodium chloride with 5% dextrose.…”

“…Our observations are similar to a study conducted by Maitra et al . [ 11 ] in 2013, who found that requirement of rescue insulin to maintain glycemic homeostasis in patients receiving dextrose as maintenance fluid during surgery was significantly higher than those who received RL.…”

“…The metabolic changes appear to be proportional to the severity of the surgical trauma with plasma cortisol and blood glucose concentration rising slightly during minor surgical procedures but significantly during major intra-abdominal operations. [ 11 ] Acute hyperglycemia has many harmful effects such as impaired endothelial nitric oxide generation with decreased vasodilatation, increased expression of endothelial and leukocyte adhesion molecules, reduced complement function, impaired neutrophil function, and increased cytokine synthesis. [ 12 ] Together these changes enhance the inflammatory response to injury and likelihood of infection.…”

Insulin Resistance, Glycemia and Cortisol Levels in Surgical Patients who Had Preoperative Caloric Load with Amino Acids

“…In our study, the postoperative blood glucose values were increased in the control group (from 5.21 mmol/l to 5.77 mmol / l), while in the study group were decreased (from 5.39 mmol / l to 4.79 mmol/l). Maitra et al [20], Zong et al [21] and Srceva et al [22] argue that the administration of different fluids in the pre-operative period differently affect the blood sugar levels. From this study and the studies of Srceva [22] and Zong [21] we can clearly conclude that pre-operatively given amino acids has strong positive impact on the postoperative blood glucose levels.…”