The Effect Of Glucose Pretreatment On Blood Sugar, Cortisol And Insulin Resistance Of Children In Operation

Objectives: To investigate the regularity of the change of children's stress, blood sugar, insulin and insulin resistance during the periods of conventional fast and anesthetic operation; to discuss the effect of glucose pretreatment on the above factors and to provide reference for maintaining the stability of glucolipid medabolism and internal environment of children in operation.Method: The subjects were 40 pediatric patients aged 3-6 years old, waiting for Cleft palate repair operations. They were rated class I risk by American Society of Anesthesiologists (ASA) criteria and they did not have obvious heart, lung, endocrine or metabolic diseases. The children had a fast for 6-12 hours. The operations were done at 8:30-9:30 a.m., and the operation last for 85-150 minutes. These 40 patients were marked as Group I, and they were randomly divided into two groups—Group IA and Group IB. After basal anesthesia, Group IA was transfused Lactate Ringer's Solution and Group IB 2.5% Glucose Ringer's Solution (The speed was 250mg/kg/h and the transfusion was finished within 60 minutes), respectively, 2 hours before the operation. Then chose 20 adult patients aged 18-35 years old, also waiting for Cleft palate repair surgeries, as the control group (Group II). They were rated class I risk by American Society of Anesthesiologists (ASA) criteria and they had not obvious heart, lung, endocrine or metabolic diseases. This GroupII had a preoperative fast for 8-10 hours. Their operations were also done at 8:30-9:30 a.m., and the operation time last for 90-140 minutes. The operations of both of these two groups were done under theconditions of general anesthesia and mechanical ventilation through tracheal cannula. 1.5-2ml venous blood samples were taken from the upper limbs of the patients before transfusion, before induction of anesthesia, 1 hour after the beginning of the operation and after the operation, respectively. Then the concentration of blood sugar, cortisol and insulin and acetone body were measured and determined. Meanwhile, the products of blood sugar concentration and insulin concentration at different points of time were counted. The reciprocals of the products of blood sugar concentration and the insulin concentration were used as the indexes of insulin sensitivity. If the blood sugar concentration was lower than 3.9mmol/l, the patient was in the hypoglycemia condition; if the blood sugar concentration was higher than ll.lmmol/1, the patient was in the hyperglycemia condition. Results:1. In Group I, 10 patients had the symptom of hypoglycemia during the preoperative fast period. The incidence rate was 25%. Acetone bodies were found in the blood of 9 patients. The rate was 22.5%. No patient in Group II had the symptom of hypoglycemia during the preoperative fast period. There was a significant difference between the two groups (P<0.01).2.The level of cortisol of Group I after fast is higher than that of before fast;but in the perioperative,the leve of Group IA is significantly higher compaed with Group IB (P<0.05).The emerged rate of acetone bodies of the Group IA isn't significgntly different from Group IB;however at the point T2 and T3,that of Group IA is significgntly higher than Group IB (P<0.05)3. The blood sugar concentration of the patients in glucose pretreatment group (Group IB) boosted. On the same time point, significant difference existed between the blood sugar concentration of Group IA and the blood sugar concentration of Group IB (P<0.01).The insulin and insulin sensitivity of the two groups had no significant differences (P>0.5).4. Before and after the operations, the blood sugar of child patients in both GroupIa and Group Ib boosted. However, the boosting extent of Group IA was significantly higher than that of Group IB (P< 0.05). Both blood insulin and insulin sensitivity of the two groups were significantly different (P< 0.05). Compared with patients in Group II, the blood sugar boosting extent of Group Uwas smaller. The difference was significant (P< 0.05). What is more, the descending extent of insulin sensitivity index of Group U was also smaller than that of Group II (P< 0.05). Conclusions:1. Conventional preoperative fast could cause hypoglycemia, especially recessive hypoglycemia in children.2. Glucose pretreatment could not only relief preoperative hypoglycemia but also relief the stress reaction and insulin resistance in the operation.3. The insulin resistances caused by stress reaction in conventional child operation was lighter than that of the adult.