Helen A. Chang, DO
Article:
“Incidence and Risk Factors for Perioperative Hyperglycemia in Children with Traumatic Brain Injury.” Anesthesia and Analgesia. Jan 2009: 108(1): 81-89. Deepak Sharma, MD, Jill Jelacic, MD et al. Departmet of Anesthesiology, University of Washington, Seattle, WA.
Summary:
This was a
retrospective cohort study of children < 13 years old you underwent urgent
or emergent craniotomy for traumatic brain injury (TBI) at Harborview Medical
Center. Data from 105 children were included and the main outcome was the
incidence of hyperglycemia, defined as serum glucose > 200mg/dl at any given
point during the pre-/intra-/postoperative period. Aside from the primary
injury insult to the pediatric brain, secondary injury occurs as result of
hypotension, hypoxia, increased ICP and hyperglycemia. These all contribute to
poor outcomes, the intensive care length of stay, and in-hospital mortality.
The group’s main findings included: 1) perioperative hyperglycemia was common, 2) the sampling frequency for the majority of children was less than one serum glucose per “anesthetic hour,” 3) intraoperative hyperglycemia was common but few patients were treated with insulin, and 4) intraoperative hypoglycemia occurred independent of insulin treatment and in fact not rare. Despite the lack of consensus regarding the definition of hyperglycemia threshold for TBI in pediatric patients, the value of 200 was utilized as it is current clinical practice. No specific glycemic control guidelines have been published for pediatric TBI when this article was accepted. The issue still looms whether transient hyperglycemia after TBI should be treated. It was also clearly stated that hypoglycemia can be equally detrimental to the outcome. The data supports that there is an underestimation of both hypo-/hyperglycemia and that continuous perioperative glucose monitoring in children specifically with TBI may be needed.
The group’s main findings included: 1) perioperative hyperglycemia was common, 2) the sampling frequency for the majority of children was less than one serum glucose per “anesthetic hour,” 3) intraoperative hyperglycemia was common but few patients were treated with insulin, and 4) intraoperative hypoglycemia occurred independent of insulin treatment and in fact not rare. Despite the lack of consensus regarding the definition of hyperglycemia threshold for TBI in pediatric patients, the value of 200 was utilized as it is current clinical practice. No specific glycemic control guidelines have been published for pediatric TBI when this article was accepted. The issue still looms whether transient hyperglycemia after TBI should be treated. It was also clearly stated that hypoglycemia can be equally detrimental to the outcome. The data supports that there is an underestimation of both hypo-/hyperglycemia and that continuous perioperative glucose monitoring in children specifically with TBI may be needed.
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