Metabolic consequences of different perioperative fluid therapies in the neonatal period

Abstract

Carbohydrate and fat metabolism during and after anaesthesia and surgery was studied in 14 neonates with major congenital non-cardiac anomalies. They were either given a glucose solution until surgery or starved for at least 4 h before surgery. Ringer-acetate alone or Ringer-acetate plus 10% glucose was used for the intraoperative fluid therapy. After anaesthesia all neonates were given a 10% glucose solution. Concentrations of glucose, free fatty acids, triglycerides, lactate, pyruvate, alanine, glycerol and 3-hydroxybutyrate were measured at predetermined intervals pre-, intra- and postoperatively. Blood glucose concentrations rose during surgery both in neonates given glucose before and during surgery (n = 6) and in neonates not given glucose before and during surgery (n = 6). Increased intraoperative levels of free fatty acids and 3-hydroxybutyrate were found in neonates not given glucose before and during surgery. The triglyceride levels were equal in both groups. In two neonates given glucose before surgery and Ringer-acetate during surgery increased levels of 3-hydroxybutyrate were found, particularly in one patient who became hypoglycaemic. In conclusion, starved neonates without intraoperative glucose supply mobilized fat and maintained blood glucose concentrations.

Intraoperative fluid and glucose management in children

“…Glucose infusion at a rate of 120 mgákg ±1 áh ±1 is suf®cient to maintain an acceptable blood glucose level and prevent lipid mobilization in infants and children (50,51). Lipid mobilization has been shown to develop in paediatric patients who received glucosefree solutions (51,52).…”

“…Intraoperative blood glucose levels were maintained by most neonates who did not receive pre and intraoperative glucose. Hypoglycaemia occurred when a preoperative glucose infusion was interrupted during the operation or in neonates younger than 48 h of age and only during the ®rst 1 h of anaesthesia (52,55). There is, however, a debate that infusions of glucose-containing solutions in neonates and infants during surgery can result in hyperglycaemia (56).…”

Dextrose‐containing intraoperative fluid in neonates: a randomized controlled trial

“…Routine use of intraoperative dextrose-containing fluids in children has declined over the years owing to evidence that normal to high blood glucose levels are maintained during surgery even with the infusion of glucose-free fluids (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). In newborns, dextrose-containing fluid is prescribed during surgery as it is believed that they need 4-8 mlÁkg À1 Ámin À1 of glucose for sustaining brain development and their limited glycogen reserve makes them susceptible to hypoglycemia without glucose supply (11)(12)(13).…”

Hyponatremia after hip arthroplasty may be related to a translocational rather than to a dilutional mechanism

“…The assumption that total lipids were constant is incorrect, but we believe that it has not biased the results. Indeed, cholesterol and triglycerides levels may decrease up to 30% after anesthesia (24,25). Therefore, we have underestimated the postoperative plasma water content, but by a very small value of 0.2%.…”