| Infants need more volume of water relatively due to their high me-tabolism. Also fluid loss is large too. Infants without foods intake are at the risk of dehydration and acidosis. The main energy supply of in-fants is glucose. The basic metabolism rate of infants is relatively high with less energy storage. The hepatic glycogen will completely con-sumed soon when blood glucose is deficient, then the process of glyco-neogenesis us stared. So glucopema may possibly happen in infants without foods intake preoperatively.Now, there is controversial in the choice of fluid infusion in oper-ation in infants. Some people considered that glucose should be in-fused routinely during operation in the infants without foods intake pre-operative to prevent and correct glucopenia. Others thought that the stress of anesthesia and operation may maintain blood glucose during anesthesia in infants. Our study is to observe the changes of inner en-vironment in infants during anesthesia , to provide guide for clinical anesthesia in infants.To compare with the influence of water and glucose intake preop-erative on blood glucose and lactate concentration before operation. To compare the effects of different fluids on the correcting results due to fast preoperative and the maintenance of dynamic balance of blood glu-cose in infants.Methods40 infants suffered lip cleft or palate cleft, 1 ~5years old, ASA I ~ II grade, were selectively for operation. The fast time for infants who were younger than 36 months is 6hours before anesthesia, infants older than 36 months 8 hours. All infants may accept fluid intake 3hours before anesthesia. Infants were divided into 2 groups random-ly, group land group 2,one for water, the other for 10% glucose po. . Each group then was divided into 2 subgroups, subgroups A and subgroups B, one for isotonic Normal saline, and the other for 3/4 tonic 2. 5% glucose ?Normal saline infused during operation. After basic anesthesia, venous blood samples were drawn from upper limbs. Mechanic ventilation began after endotracheal intubation. The mainte-nance of anesthesia is with N02 inhalation, propofol infusion and re-gional anesthesia with lidocaine.At the end of operation, venous blood samples 1 -1.5 ml were drawn again to detect the concentration of blood glucose, lactate, BE, Na + in serum, blood glucose less than 3 mmol/1 was considered as hypoglycemia, higher than 11 mmol/1 as hyperglycemia.ResultNo infants suffered hypoglycemia throughout the study. No signif-icant difference in blood glucose existed between group 1 and group 2 preoperatively. The average blood glucose concentration increased post - operation in both groups, but in normal range. Just one case in group 2A suffered hyperglycemia. Lactate values in group 1 were re-markably lower than those in group 2 preoperatively. Lactate value in group 1 were significantly lower than those in group 2 preoperatively. Compare to the values preoperative, Na + concentration postoperative deceased in some degree . But there was not significant change. All values were in normal range.DiscussionHyperglycemia or hypoglycemia may do harm to our bodies , so it is very important to maintain the dynamic balance of blood glucose preoperatively. In this study, blood glucose of all infants were in nor-mal range, but lactate concentration in group 2 were obviously lower than those in group 1, which showed that fast preoperative will not lead to hypoglycemia in infants with good nutrition during short opera-tion. But during the preoperative period gluconeogenesis has began due to the consumption of glucose stored in the body. So suitable dose of glucose fluid infused preoperatively may prevent hypoglycemia, and avoid the occurrence of gluconeogenesis. The dynamic balance of glu-cose is the result of effects of glucagons, corticosteroid, catecholamine and insulin. Glucagon may increase the blood glucose through glycog-enolysis, increase of gluconeogenesis and decrease of glucose toler-ance , and it may accelerate the catabolism of fat a... |
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