Effect of remifentanil and dexmedetomidine infusion in pediatric patients’ blood glucose levels undergoing cranioplasty operation
Özge Özen, Sehend Debbağ, Bengisu Koç, Bensu Karakoyak, Özgür Canbay
Hacettepe Üniversitesi Hastanesi
Giriş: Cranioplasty-surgery can cause inflammatory responses that increases plasma levels of cytokine and catecholamine, resulting in hyperglycemia(1). The resulting hyperglycemia can adversely affect patient outcomes by producing hazardous effects thus increasing the postoperative complications. Both remifentanil/dexmedetomidine are frequently used in pediatric patients for analgesia during surgeries(2). Remifentanil/dexmedetomidine have been shown to effectively suppress the hormonal stress response during surgery, and can mitigate hyperglycaemic responses. However blood-glucose-levels associated with remifentanil/dexmedetomidine administration isn’t identified clearly(3). This study aimed to identify the effects of our fluid management strategy besides, the effects of remifentanil/dexmedetomidine infusions on blood-glucose-levels, in pediatric patients undergoing cranioplasty-operation.
Gereç ve Yöntem: After the approval of Hacettepe University ethics committee, data of the 44 patients underwent cranioplasty-surgery between 2016-2021were reviewed retrospectively. Patient demographics accompanying syndromes, intra/postoperative hypo/hyperglycemia were recorded. Only balanced electrolyte solutions were given to the patients perioperatively, none of them were given any dextrose containing fluids.
Bulgular: Among 44 patients included in this study, 18 were ASA-I and 26 were ASA-II, 10 had Apert-Syndrome and 3 had Crouzon-Syndrome. The mean age was 19,65(min:6-max:108)months. The mean operation time was 266,47(min:180-max:405)minutes. We used remifentanil for maintenance of anesthesia in 27patients(%61,36)and dexmedetomidine in 17patients(%38,63). Two-patients in dexmedetomidine and 6patients in remifentanil group had hyperglycemia intraoperatively and hyperglycemia was observed in 1of the patients of remifentanil group just before the onset of surgery. Hypoglycemia was not observed in either group.
Tartışma ve Sonuç: Although we didn’t administer dextrose containing fluids to any of the patient no hypoglycemia was observed but hyperglycemia was found in 6of the remifentanil and 2of the dexmedetomidine groups which was statistically insignificant(p=0,455). Permission of preoperative clear fluid intake like water/apple juice as suggestion of ERASprotocols prevents the preoperative dehydration and also optimize the fluid balance which makes the perioperative fiuid management easier. Since this study is retrospective, it should be supported by further prospective studies.
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