Effect of minimizing preoperative fasting on perioperative blood glucose homeostasis in children

Two hundred healthy, unpremedicated children, ages 1–10 years, scheduled for elective outpatient surgery were studied in order to examine the effect of minimizing preoperative fasting on perioperative blood glucose concentrations in paediatric patients. None of the patients ingested solids after midnight. On the day of surgery, the children were assigned to one of two groups. Group A children (n= 113) were not allowed any liquids for at least 6 h prior to surgery (NPO). Children in Group B (n= 87) ingested 10 ml·kg^?1 of apple juice 2–4 h prior to the induction of anaesthesia. All patients received lactated Ringer's solution intraoperatively, unless BG at induction was < 50 mg·dl^?1 (2.8 m·mol·l^?1) in which case dextrose 2.5% in lactated Ringer's solution was administered. None of the patients who received apple juice was hypoglycaemic during induction of anaesthesia. However, two children in the NPO group had blood glucose values ± 50 mg·dl^?1 (2.8 m·mol·l^?1) at the time of induction of anaesthesia. Thirteen (11%) patients in Group A and 6 (7%) patients in Group B showed either no change or a further decrease in their postoperative BG concentration as compared with their induction values. Two of 43 patients in Group A and 2 of 41 patients in Group B had gastric fluid volumes > 0.4 ml/kg. All patients in both groups had gastric pH < 2.5. This study shows that gastric fluid volume and pH following a 2–4 h fast are not different from the values measured in children who were subjected to a traditional fasting period of 6 h or longer. Moreover, apple juice consumed 2–4 h prior to surgery neither buffers gastric pH nor does it modify intraoperative glucose homeostasis in children.     

A comparison of 5% dextrose in 0.9% normal saline versus non-dextrose-containing crystalloids as the initial intravenous replacement fluid in elective surgery

Intravenous fluid replacement in adult elective surgery is often initiated with dextrose-containing fluids. We sought to determine if this practice resulted in significant hyperglycaemia and if there was a risk of hypoglycaemia if non-dextrose-containing crystalloids were used instead. We conducted a randomized controlled trial in 50 non-diabetic adult patients undergoing elective surgery which did not involve entry into major body cavities, large fluid shifts, or require administration of >500 ml of intravenous fluid in the first two hours of peri-operative care. Patients received 500 ml of either 5% dextrose in 0.9% normal saline, lactated Ringer's solution, or 0.9% normal saline over 45 to 60 minutes. Plasma glucose, electrolytes and osmolarity were measured prior to infusion, and at 15 minutes and one hour after completion of infusion. None of the patients had preoperative hypoglycaemia despite average fasting times of almost 13 hours. Patients receiving lactated Ringer's and normal saline remained normoglycaemic throughout the study period. Patients receiving dextrose saline had significantly elevated plasma glucose 15 minutes after completion of infusion (11.1 (9.9-12.2, 95% CI) mmol/l). Plasma glucose exceeded 10 mmol/l in 72% of patients receiving dextrose saline. There was no significant difference in plasma glucose between the groups at one hour after infusion, but 33% of patients receiving DS had plasma glucose > or = 8 mmol/l. We conclude that initiation of intravenous fluid replacement with dextrose-containing solutions is not required to prevent hypoglycaemia in elective surgery. On the contrary, a relatively small volume of 500 ml causes significant, albeit transient, hyperglycaemia, even in non-diabetic patients.     

Evaluation of current paediatric guidelines for fluid therapy using two different dextrose hydrating solutions

Simplified guidelines for intra-operative fluid therapy were evaluated in two groups of children (aged 3 months-10 years) undergoing minor non-haemorrhagic surgical procedures, randomly assigned to receive either 5% or 2.5% dextrose in 0.3% or 0.4% normal (N) saline. Blood samples were obtained at the time of induction and upon arrival in the recovery room. Fasting time was on average greater than 10 h and hypoglycaemia, defined as blood glucose less than 3.5 mmolċl⁻¹, was observed in 7.4% of the children at the time of induction. In both groups, blood glucose increased at the end of surgery, this increase being more significant in children receiving 5% dextrose than in those receiving 2.5% dextrose. In both groups, post-operative blood glucose values were higher in children of less than 4 years of age than in those aged 4 and over. Blood glucose changes were associated with a decrease in plasma sodium, this decrease being greater in children receiving 5% dextrose in 0.3 _N saline, especially in those less than 4 years of age. This study suggests that the use of a 5% dextrose hydrating solution in 0.3 _N saline is more likely to result in hyperglycaemia and hyponatraemia than a 2.5% dextrose in a 0.4 _N saline, particularly in children younger than 4 years of age.     

Comparison of two anesthesia techniques on perioperative insulin response to i.v. glucose infusion in children

Perioperative blood glucose and insulin levels were measured in children (1–9 years of age) randomly assigned to two groups according to anesthesia technique, general anesthesia (group GA) or general anesthesia combined with regional anesthesia (group RA). Children in the GA group (n= 10) received halothane and opioids, while children of the RA group received epidural anesthesia with bupivacaine (0.25%) and adrenaline combined with halothane anesthesia (n= 10). Children in both groups received 2.5% dextrose in 0.4 N saline administered by volumetric infusion pumps throughout the study period, the infusion rate being adapted to the child's age. Blood samples for glucose and insulin determinations were obtained: at induction, at the end of surgery, and 30, 60 and 120 min after surgery. In response to an identical glucose load, blood glucose levels increased significantly in both groups (P<0.001), while no differences between groups were observed. Insulin levels did not change significantly postoperatively in the GA group (P = 0.058), while a significant increase was observed in the RA group (P<0.001). Insulin/blood glucose ratio increased significantly only in the RA group (P<0.05). The higher insulin secretion in response to glucose infusion in the RA group compared to the GA group may indicate an increased peripheral insulin resistance after regional anesthesia or, more likely, this secretion may be beneficial in contributing to improve postoperative nitrogen balance.     

Four different fluid regimes during and after minor paediatric surgery—a study of blood glucose concentrations

In order to evaluate the efficiency of glucose homeostatic mechanisms in otherwise healthy infants and children during and after anaesthesia and surgery four different fluid regimes were studied in 40 patients, 6–24 months old. The four regimes all resulted in a total fluid volume of 10 ml·kg^?1·h^?1 intraoperatively and 3 ml·kg^?1 h^?1 postoperatively. One group received a combination of glucose 300 mg·kg^?1h^?1 and Ringer acetate intraoperatively and glucose postoperatively, a second group was given the same intraoperative fluid followed by glucose free Ringer acetate postoperatively. A third group received Ringer acetate both intra- and postoperatively and a fourth group was given Ringer acetate intraoperatively and glucose postoperatively. Blood glucose concentrations were measured after induction (Preop.), immediately after surgery (Postop.) and after 30, 60 and 120 min. Increased blood glucose concentrations were found in all children immediately after surgery. The concentrations were highest among children given glucose. Postoperatively blood glucose remained elevated in children receiving glucose after surgery. In patients without postoperative glucose supply blood glucose concentrations declined. Hypoglycaemia was not seen on any occasion. The differences in blood glucose concentrations with different regimes were significant but small. We conclude that the studied group of healthy children appeared to be capable of regulating blood glucose levels within normal limits with or without intraoperative glucose and also if the intraoperative glucose supply was interrupted postoperatively.     

Effets de différents solutés de remplissage sur l'osmolalité plasmatique

ObjectiveAs hydratation of the normal brain is much more dictated by osmotic gradients than by hydrostatic or oncotic pressures, this study aimed to compare the effect of the infusion of currently used volume loading solutions on plasma osmolality.Study designRandomized, comparative trial.PatientsThirty ASA 1–2 patients, scheduled for lumbar intervertebral disc surgery were randomly allocated to three groups receiving either 2,000 mL of lactated Ringer's solution (RL, n = 10), 750 mL of hydroxyethylstarch 6% (HEA, n = 10) or 2,000 mL of normal saline (NaCl, n= 10).MethodsBaseline osmolality, natraemia, glycaemia and protidaemia were measured before induction of anaesthesia (T1), after the infusion of 375 mL of hydroxyethylstarch or 1,000 mL of cristalloids (T2) and at the end of the infusion (T3).ResultsThe three groups were identical for age, weight, initial plasma osmolality and natraemia. However, osmolality in the RL group was decreased at T2 and T3 compared to T1 (respectively: 299±5 mOsm·kg⁻¹, 295 ± 4 mOsm·kg⁻¹ and 292 ±5 mOsm·kg⁻¹. Osmolality at T2 and T3 was also lower in the RL group compared to the HEA and NaCl groups (respectively: 301 ± 6 mOsm·kg⁻¹ and 304 ± 13mOsm·kg⁻¹ for T2 and T3 in the HEA group, and 299 ± 5 mOsm·kg⁻¹ and 298 ±5 mOsm·kg⁻¹ in the NaCl group). In the HEA and NaCl groups, osmolality was unchanged at T2 and T3 compared to T1.ConclusionBoth normal saline and hydroxyethylstarch 6% maintain plasma osmolality, whereas Ringer lactate tends to decrease it. For that reason normal saline and hetastarch 6 %, but not lactated Ringer's solution, may be administered in patients experiencing blood-brain barrier damage.     

The Effect of HES (130/0.4) Usage as the Priming Solution on Renal Function in Children Undergoing Cardiac Surgery

Background: Experience with hydroxyethyl starch (HES) in children is limited. This study was conducted to observe the effects of HES or Ringer’s lactate (RL) usage as the priming solution on renal functions in children undergoing cardiac surgery. Methods: After ethical committee approval and parent informed consent, 24 patients were included in this prospective, randomized study. During cardiopulmonary bypass (CPB), Group I received RL and Group II received HES (130/0.4) as priming solution. Serum creatinine, blood urea nitrogen (BUN), β2-microglobulin, cystatin C, and urinary albumin and creatinine, serum, and urine electrolytes were analyzed after the induction (T1), before CPB (T2), during CPB (T3), after CPB (T4), at the end of the operation (T5), on 24th hour (T6), and on 48th hour postoperatively (T7). Fractional sodium excretion (FENa), urinary albumin/creatinine ratio, and creatinine clearance were calculated. Drainage, urine output, inotropes, diuretics, and blood requirements were recorded. Results: In both the groups, β2-microglobulin was decreased during CPB and cystatin C was decreased at T3,T4, and T5 periods (p < 0.05) and the levels remained within the normal range. Creatinine clearance did not differ in the HES group, but increased in the RL group (p < 0.05). Urine albumin/creatinine ratio was increased (p < 0.05) after CPB in the HES group, and it increased at T3, T4, and T5 in the RL group (p < 0.05). There were no differences in cystatin C, β2-microglobulin, FENa, urine albumin/creatinine ratio, creatinine clearance, total fluid amount, urine output, drainage, and inotropic and diuretic requirements between the groups. Conclusion: We conclude that usage of HES (130/0.4) did not have negative effects on renal function, and it can be used as a priming solution in pediatric patients undergoing cardiac surgery.     

A novel isotonic‐balanced electrolyte solution with 1% glucose for perioperative fluid management in children‐ an animal experimental preauthorization study

Background: The recommendations for perioperative maintenance fluid in children have been adapted from hypotonic to isotonic electrolyte solutions with lower glucose concentrations (1–2.5% instead of 5%) to avoid hyponatremia or hyperglycemia. Objective: The objective of this prospective animal study was to determine the margin of safety of a novel isotonic‐balanced electrolyte solution with 1% glucose (BS‐G1) in comparison with normal saline with 1% glucose (NS‐G1) in the case of accidental hyperhydration with a focus on acid–base electrolyte balance, glucose concentration, osmolality and intracranial pressure in piglets. Methods: Ten piglets (bodyweight 11.8 ± 1.8 kg) were randomly assigned to receive either 100 ml·kg^?1 of BS‐G1 or NS‐G1 within one hour. Before, during and after fluid administration, electrolytes, lactate, hemoglobin, hematocrit, glucose, osmolality and acid–base parameters were measured. Results: Unlike BS‐G1, administration of NS‐G1 produced mild hyperchloremic acidosis (base excess BS‐G1 vs NS‐G1, baseline 1.9 ± 1.7 vs 2.9 ± 0.9 mmol·l^?1, study end 0.2 ± 1.7 vs ?2.7 ± 0.5 mmol·l^?1, P < 0.05, chloride BS‐G1 vs NS‐G1 baseline 102.4 ± 3.4 vs 102.0 ± 0.7 mmol·l^?1, study end 103.4 ± 1.8 vs 109.0 ± 1.4 mmol·l^?1P < 0.05). The addition of 1% glucose led to moderate hyperglycemia (P < 0.05) with a concomitant increase in serum osmolality in both groups (P < 0.05). Conclusion: Both solutions showed a wide margin of safety in the case of accidental hyperhydration with less acid–base electrolyte changes when using BS‐G1. This novel solution could therefore enhance patient’s safety within the scope of perioperative volume management.     

BLOOD-GLUCOSE CONCENTRATIONS DURING ANAESTHESIA IN CHILDREN: Effects of starvation and perioperative fluid therapy

Blood glucose concentration, pH and standard bicarbonate concentrationwere measured in 70 anaesthetized children aged between 2 weeksand 22 months before and following surgery. The duration ofstarvation varied between 4 and 14h (mean 5.8h). The lowestblood-glucose concentration before operation was 2.9 mmol litre^–1(53 mg dl^–1). Preoperative blood-glucose concentrationswere not influenced by the age or weight of the child, or theduration of starvation. During operation the children receivedeither a balanced Ringer acetate solution (group A) or a Ringerglucose solution containing 2.5% glucose (group B). In thesepatients the preoperative starvation did not result in hypoglycaemiaand, during surgery, increases in blood-glucose concentrationwere found even in those children receiving a glucose-free fluidregimen     

Changes in serum potassium, calcium and creatine kinase following suxamethonium administration in children with and without strabismus

The immediate changes in serum potassium and calcium and 24-h changes in creatine kinase (CK) following suxamethonium administration were compared in children undergoing strabismus repair or tonsillectomy following induction of anaesthesia with thiopentone or halothane. A separate group of children were anaesthetized with isoflurane and did not receive suxamethonium. There was a significant increase ( P < 0.05) in serum potassium of 0.26 and 0.56 mmolċ⁻¹ following halothane-suxamethonium induction and a significant decrease ( P < 0.05) of 0.35 and 0.13 mmolċ⁻¹ after thiopentone-suxamethonium induction in the strabismus and tonsillectomy groups respectively. There was an increase in the 24 h CK values of 624 and 694 uċl⁻¹ ( P < 0.05) in patients receiving halothane-suxamethonium induction and of 43 (NS) and 247 uċ⁻¹ ( P < 0.05) in patients receiving thiopentone-suxamethonium induction in the strabismus and tonsillectomy groups respectively. Suxamethonium administration was associated with a small but sometimes significant ( P < 0.05) decrease in total serum calcium concentrations (0.036 to 0.049 mmolċ⁻¹). Changes in all indices were minimal in children anaesthetized with isoflurane. It is concluded that the administration of halothane and suxamethonium is the main cause for the changes in serum potassium and CK and not the presence of strabismus.     

Maltose as an energy substrate during surgery: Comparison of maltose with glucose

To evaluate the usefulness of maltose as an energy substrate to be administered during surgery, five per cent maltose in lactated Ringer’s solution and five per cent glucose in lactated Ringer’s solution were administered to 10 cases each, at a rate of 5 ml.kg^i-1 hour (0.25 g.kg^i-1 hour as sugar) for two hours from the start of oral surgery, and their metabolic effects were compared. The maltose group showed a smaller increase in blood sugar level than the glucose group immediately after the completion of infusion. The mean plasma concentration of maltose reached a maximum of 121.6 mg/dl, and it remained at 12.3 mg/dl at four hours, indicating that the retention time of maltose in blood was longer than that of glucose. The mean recovery of sugar from four-hour urine samples was 3.26 per cent in the maltose group and 0.06 per cent in the glucose group respectively, showing greater urinary excretion by the maltose group. Plasma insulin was elevated less after maltose than after glucose infusion. The elevation following maltose infusion was considered not to be due to the administration of maltosc per se, but to glucose produced from the maltose in the body. The anti-ketogenic effect of maltose was comparable to and tended to last longer than that of glucose. From overall assessment it was concluded that maltose exerts essentially the same metabolic effects as glucose when used under these conditions.     

两种不同晶体液预扩容对剖宫产术后炎性反应的影响

目的探讨两种不同晶体液预扩容对剖宫产术产妇术后炎性反应的影响。方法选择择期剖宫产产妇60例,随机双盲分为复方乳酸钠组(RL组)和复方醋酸钠组(RA组),每组30例。麻醉前10 ml/kg晶体液预扩容,输液速率15~20 ml·kg-1·h-1。取左侧卧位行腰-硬联合麻醉。术中持续输入相应晶体液。分别在开始输液时(T1)、手术结束时(T2)、手术后4 h(T3)、24 h(T4)抽取静脉血,检测产妇血清中IL-6、TNF-α和CRP水平。结果 T1、T4时两组产妇CRP、IL-6和TNF-α水平差异无统计学意义。T2、T3时RA组CRP、IL-6和TNF-α水平明显高于RL组(P0.05)。结论复方醋酸钠导致产妇术后炎性因子释放的作用明显强于复方乳酸钠。     

Pharmacokinetics of rectal paracetamol after major surgery in children

Glycogelatin capsular suppositories containing a paracetamol slurry 40 mg·kg^-1 were given PR to 20 children (12 months-17 yrs) after major orthopaedic surgery and plasma concentrations of paracetamol measured for up to 18 h. The mean maximum concentration (C_max) was 0.115 (SD 0.049) mmol·l^-1. Peak concentration occurred (T_max) at 2.3 (SD 1.2) h. Mean concentration was 0.07 (SD 0.03) mmol·l^-1 at six h. Apparent paracetamol clearance was 5.8 ml·min^-1·kg^-1. The plasma concentration of paracetamol associated with analgesic effectiveness in children is unknown, but antipyretic effects are seen in the range 0.066–0.130 mmol·l^-1. Paracetamol suppositories 40 mg·kg^-1 given perioperatively achieve effective therapeutic antipyretic plasma concentrations within 1–2 h. The timing is coincident with the recovery phase of short duration paediatric surgery. The coefficient of variance of C_max was 43%. Some individual patients may not achieve a C_max which is therapeutic.     

A study of blood glucose in paediatric laparoscopy

BACKGROUND: There are few studies on stress responses to laparoscopic surgery in children. This study was conducted to assess the blood glucose levels in children undergoing laparoscopy. We also studied the effect of two different intravenous (i.v.) solutions on blood glucose in open and laparoscopic procedures. METHODS: One hundred and twenty healthy children, aged 2-12 years, undergoing either open or laparoscopic surgery, were randomized to receive either dextrose normal saline (DS) or Ringer's lactate peri-operatively (RL). All patients had blood glucose measurements performed immediately after induction but prior to the i.v. infusion of any fluid. Blood glucose was again measured 1 h after induction in the open cases and 1 h after insufflation in the laparoscopy cases. RESULTS: In the groups, baseline blood glucose values were comparable. In all groups, blood glucose concentrations increased from the immediate post-induction (baseline) values. When RL was infused, the 1-h blood glucose was higher in the laparoscopy group as compared with the open group. However, when DS was infused the difference between the 1-h blood glucose in the open and laparoscopic procedures was not statistically significant. In the laparoscopy group, the 1-h blood glucose value was significantly higher in the patients receiving dextrose solution. CONCLUSION: Laparoscopic procedures in children are associated with a rise in blood glucose levels similar to open surgery. The hyperglycaemic response was more pronounced when dextrose-containing solutions were infused peri-operatively.     

钠钾镁钙葡萄糖注射液扩容对术中血糖、电解质和酸碱平衡的影响

目的比较钠钾镁钙葡萄糖注射液和复方乳酸钠注射液扩容对术中血糖、电解质及酸碱平衡的影响。方法择期行胃肠道手术患者30例,采用随机数字法分为研究组(n=16)和对照组(n=14),研究组使用钠钾镁钙葡萄糖注射液扩容,对照组使用复方乳酸钠注射液扩容,分别在入室后以15ml·kg-1·h-1的速度输注相应液体。分别于输液前(T0)、输液量为10ml/kg(T1)、20ml/kg(T2)和30ml/kg(T3)时检测患者血糖、血乳酸、电解质及pH值等。结果输液后研究组血糖明显升高(P<0.05),血乳酸无明显变化,血pH明显降低(P<0.05);对照组血乳酸明显升高(P<0.05);两组电解质水平均无明显变化。结论钠钾镁钙葡萄糖注射液在扩容、维持电解质及酸碱平衡方面与复方乳酸钠注射液效果相当,可避免大量输入复方乳酸钠注射液所致的乳酸升高,但当大量输注钠钾镁钙葡萄糖注射液时可导致一定程度的血糖升高。     

Peri-operative glucocorticoid replacement therapy in transsphenoidal pituitary adenoma surgery: a prospective controlled study

Summary Background. We set out to prospectively study the peri-operative changes of the hypothalamic-pituitary-adrenal axis (HPA), and to test the hypothesis that the peri-operative corticoid replacement regimen used at the authors’ institution in patients with impaired HPA undergoing transsphenoidal pituitary adenoma surgery is adequate. Method. Thirty seven patients (21 females, 16 males, mean age 50.6 years) underwent transsphenoidal pituitary adenoma surgery (mean tumour diameter 20.6 mm, 13 tumours hormone-secreting). The HPA functions of these patients were classified as impaired (group A, n = 15) or preserved (group B, n = 22) according to the results of a pre-operative corticotrophin releasing-hormone test (CRHT). Eleven patients (9 female, 2 male, mean age 53.6 years) without pituitary adenomas and with a preserved HPA (as assessed by medical history and morning serum cortisol (MSC) measurements), undergoing decompressive surgery for degenerative lumbar disc disease, were also studied (group C). On the day of surgery, the patients of group A received 100 mg hydrocortisone (HC) replacement therapy, which was thereafter gradually tapered off in a standardised fashion. The patients of groups B and C were not treated with corticoids. Pre-operative, intra-operative and post-operative variables of these three patient groups were compared. Findings. The urinary free cortisol excretion (UFC) in group A declined from 6732 ± 7683 μg/d on the day of surgery to 305 ± 358 μg/d on the 10^th post-operative day. In group B, the respective UFC values were 12851 ± 16278 μg/d and 223 ± 235 μg/d. In both of these groups, the mean UFC did not fall into the normal range during the first ten post-operative days. On none of the post-operative days, was there a significant difference between the UFC of groups A and B. The UFC values of group C dropped from 177 ± 157 μg/d on the day of surgery to 87 ± 61 μg/d on post-operative day six, reaching the normal range from the 2^nd post-operative day onwards. All UFC values of group C were significantly lower than those of group A and B. None of the evaluated clinical, laboratory and MRI parameters, as disclosed by uni- and multivariate analysis, showed any significant influence on the peri-operative UFC values. Conclusions. The peri-operative UFC of pituitary adenoma patients with preserved HPA was very high, as compared to patients with degenerative lumbar disc disease. The present study showed for the first time, that the proposed regimen of peri-operative corticoid replacement therapy used in patients with pituitary adenomas and impaired HPA raised cortisol levels to match the physiological increase of UFC in patients with pituitary adenoma surgery and preserved HPA. However, although statistically not significant, the UFC of patients with pituitary adenomas and preserved HPA seemed considerably higher on the day of surgery than in patients with pituitary adenomas and HPA impairment. Although there is no evidence to make it mandatory, administration of 150 mg instead of 100 mg HC substitution on the day of pituitary adenoma surgery in patients with HPA impairment may be prudent. Correspondence: Rudolf A. Kristof, M.D., Universit?tsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany.     

PREOPERATIVE STARVATION AND BLOOD GLUCOSE CONCENTRATIONS IN CHILDREN UNDERGOING INPATIENT AND OUTPATIENT ANAESTHESIA

Blood glucose concentrations were measured in 82 children undergoinginpatient anasthesia and in 46 children undergoing anaesthesiaas outpatients. The children were aged between 6 months and9yr. Outpatients were fasted from bedtime, while inpatientswere randomly allocated to two groups. In group A the childrenwere fasted from bedtime, whereas in group B the children werefed 6h before anaesthesia. There was no difference in mean bloodglucose concentration between the fasted inpatients and outpatientsnor between children younger than, or older than, 4 years ofage. A blood glucose concentration of less than 40mgdl^–1was found in only one of the fasted children (1%). The meanblood glucose concentration was greater in group B than A, butonly significantly so for children older than 4 yr. It is concludedthat to minimize- the risks of hypoglycaemia and inhalationof vomit on induction of anaesthesia children older than 6 monthsshould be fasted overnight and operated on in the morning.     

Blood glucose and insulin levels during epidural anaesthesia in children receiving dextrose-free solutions

Summary
This study was designed to evaluate the hyperglycaemic response to surgery in two groups of children undergoing minor surgical procedures and receiving dextrose-free solutions during the perioperative period. Twenty-four unpremedicated children of less than eight years of age were randomly assigned to receive either general anaesthesia using halothane, vecuronium and narcotics (GA group, n = 12) or general anaesthesia (halothane, vecuronium) combined with caudal anaesthesia (RA group, n = 12). In both groups blood glucose and insulin concentrations were measured during inhalational induction (T0), at the end of surgery (T1) and 30, 60, 120 min after surgery (T2, T3, T4). A significant hyperglycaemic response to surgery was observed in the GA group, while no changes in blood glucose were observed in the RA group. The maximal blood glucose value was observed 30 min after completion of surgery. Insulin changes followed closely changes in blood glucose values. This study demonstrates that epidural anaesthesia was effective in reducing the hyperglycaemic response to surgery in children scheduled for minor surgical procedures. The lack of increase in blood glucose values under epidural anaesthesia suggests that blood glucose levels should be monitored during the perioperative period, especially after a prolonged fasting time and when oral intake might be delayed.     

诱导期急性超容量液体填充对腹腔镜结肠直肠手术老年病人内脏灌注的影响

目的：观察全麻诱导期应用晶体液或胶体液行急性超容量液体填充（acute hypervolemic fluid infusion,AHFI）对腹腔镜结肠直肠手术老年病人内脏灌注的影响。方法：腹腔镜结肠直肠手术老年病人30例,ASAⅠ～Ⅱ级,男17例,女13例,年龄65～85岁,随机分为乳酸钠林格液组（R组）、琥珀酰明胶组（G组）和高渗氯化钠羟乙基淀粉40注射液组（H组）,每组各10例,全麻诱导开始后30 min内分别输注乳酸钠林格液、琥珀酰明胶12 mL/kg,或高渗氯化钠羟乙基淀粉40注射液3.5 mL/kg。在诱导前即刻（T0）,AHFI结束时（T1）,气腹后5 min（T2）、15 min（T3）、30 min（T4）、60 min（T5）,结束气腹后5 min（T6）、15min（T7）、25min（T8）时监测并记录血流动力学指标、动脉血气分析结果和胃黏膜张力计测定值。结果：3组胃黏膜-血二氧化碳分压（Pg-aCO2）在T1时低于基础值;在T2降至最低点,且G组明显低于R组;随后,3组Pg-aCO2较T2逐渐升高,且R组T4~7和H组T6时Pg-aCO2高于基础值。3组胃黏膜pH随着气腹时间的延长而逐渐降低,R和H组pHi在T5~8低于7.32,但G组pHi在各时点均高于7.32。R组心指数和心室收缩加速指数在T2明显低于基础值,T6时中心静脉压明显低于G和H组。H组T1～7Na＋高于R和G组。结论：诱导期AHFI能改善腹腔镜结肠直肠手术老年病人内脏器官的血流灌注。与R和H比较,G在较长时间气腹（60 min）仍能维持良好的内脏灌注。     

Dose of propofol required to insert the laryngeal mask airway in children

We have assessed the ease of insertion of the Brain Laryngeal Mask Airway (LMA) after induction of anaesthesia with propofol in 60 healthy unpremedicated children aged between four and nine years. Patients were randomly allocated into three groups: group A = propofol 2.5 mg·kg^?1; group B = propofol 3 mg·kg^?1 and group C = propofol 3.5 mg·kg^?1. Propofol was mixed with lignocaine 0.5 mg·kg^?1. Insertion conditions were assessed subjectively as good, acceptable, unacceptable or impossible. Insertion of the LMA was possible in all patients. Good and acceptable conditions were obtained in 35%, 70% and 95% in groups A, B, and C respectively (P < 0.0001). There was no statistically significant inter group variation in systolic and diastolic arterial pressure or in heart rate for five min after induction. All measured cardiovascular changes were considered to be clinically insignificant in healthy children. We conclude it is safe and effective to insert a LMA immediately after induction of anaesthesia with propofol 3.5 mg·kg^?1.