Anales de Pediatría (English Edition) (Aug 2018)
A comparison of post-surgical plasma glucose levels in patients on fluids with different glucose concentrations
Abstract
Objective: To compare plasma glucose levels and incidence of hyperglycaemia in the post-operative period after general surgery using fluids with different glucose. Methodology: A randomised, open-label, non-blind, clinical trial was conducted on patients admitted to Paediatric Intensive Care Unit after elective surgery. The inclusion criteria were from 6 months to 14 years of age, with a weight greater than 6 kg, onset glucose level > 60 mg/dL, and a signed informed consent, with no oral intake and maintenance intravenous fluid therapy using fluids with 3.3% or 5% glucose. Plasma glucose levels were measured before surgery, on admission, and 8, 24, and 48 h, with the mean glucose levels and incidence of hyperglycaemia (glucose level > 150 mg/dL) in both groups being compared. Results: A total of 60 patients received glucose/saline 1/3 (51 mEq/L sodium and 33 g/L glucose), and 70 glucose/saline 5/0.9% (154 mEq/L sodium and 50 g/L glucose). Mean glucose levels were higher in the group receiving glucose 5%, with no statistical difference. There was no significant difference in the incidence of hyperglycaemia; 8 h: 26% in the 3.3% group vs. 21.3% in the 5% group (P = .63); 24 h: 20% vs. 22.7% (P = .8); and 48 h: 19% vs. 23.1% (P = .78). Conclusions: The use of fluids with 3.3% glucose in the post-operative period of general surgery maintains mean glucose levels in a similar range to that of patients receiving fluids with 5% glucose, with no difference in the incidence of hyperglycaemia. Resumen: Objetivo: Comparar los niveles de glucemia e incidencia de hiperglucemia en el postoperatorio de cirugía general usando sueros con diferente concentración de glucosa. Metodología: Ensayo clínico aleatorizado, abierto, no ciego, en pacientes no diabéticos, que ingresan en Cuidados Intensivos Pediátricos tras cirugía electiva, de 6 meses a 14 años, peso superior a 6 kg, glucemia >60 mg/dl y firma de consentimiento informado, manteniéndose a dieta con sueroterapia de mantenimiento intravenosa mediante suero con glucosa al 3,3 o 5%. Se determinan niveles de glucemia preoperatoria, al ingreso, y a las 8, 24 y 48 h, comparando los valores medios y la incidencia de hiperglucemia (glucemia > 150 mg/dl) en ambos grupos. Resultados: Un total de 60 pacientes recibieron suero glucosalino 1/3 (51 mEq/l de sodio y 33 g/l de glucosa) y 70 pacientes suero glucosalino 5/0,9% (154 mEq/l de sodio y 50 g/l de glucosa). La glucemia media fue mayor en el grupo al 5%, sin diferencia estadística. No hubo diferencia en la incidencia de hiperglucemia; 8 h: 26% del grupo 3,3% vs. 21,3% del grupo 5% (p = 0,63); 24 h: 20% vs. 22,7% (p = 0,8); 48 h: 19% vs. 23,1% (p = 0,78). Conclusiones: En el postoperatorio de cirugía general, el uso de soluciones glucosadas al 3,3% consigue niveles de glucemia similares a los detectados en pacientes que reciben suero con glucosa 5%, con una incidencia de hiperglucemia similar.
