MedWire News: Hyperglycemia is common in children undergoing urgent or emergent craniotomy for traumatic brain injury (TBI), increasing their risk for poor outcomes, say US researchers.
The team reports that 45% of 105 such children (aged ≤13 years) suffered peri-operative hyperglycemia (glucose ≥200 mg/dl). Also, two (2%) had an episode of hypoglycemia (glucose ≤60 mg/dl) that was not related to insulin treatment.
In all, 86 patients had 95 glucose values taken pre-operatively, 94 had 244 values taken intra-operatively, and 101 children had 292 postoperative glucose measurements.
“Since intermittent intra-operative sampling may have under-estimated the actual frequency of both hyper-and hypoglycemia; more frequent if not continuous, peri-operative glucose monitoring in children with TBI may be needed,” suggest Monica Vavilala (Harborview Medical Center, Seattle, Washington) and colleagues.
Transient hyperglycemia occurred in 28% of the patients and 17% suffered persistent hyperglycemia.
The researchers note that both hyper- and hypoglycemia have been associated with poor postoperative outcomes. They believe the detrimental effects of hypoglycemia may have contributed to the occurrence of persistent hyperglycemia, as physicians may be reluctant to give insulin treatment for fear of causing hypoglycemia. Although 18 children suffered persistent hyperglycemia, just six received insulin.
Hyperglycemia was associated with age younger than 4 years, a Glasgow Coma Scale score of 8 or lower, and the presence of multiple lesions, including subdural hematoma.
“A continuous glucose monitoring system with real-time read-outs might be one solution to decrease sampling bias and valuable for the real-time detection and treatment of hyper- and hypoglycemia during the peri-operative period,” the team concludes in the journal Anesthesia & Analgesia.