Glucose-Containing/Glucose-Free Alternating Intraoperative Fluid Regimen Modulates Blood Glucose Levels In Neurosurgical Non-Diabetic Patients
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This study aimed to evaluate the impact of glucose administration in form of 5% dextrose in 0.9% saline (DNS) alternately with lactated ringer's solution (RL) starting prior to induction of anesthesia on blood glucose level (BGL) in patients assigned to have neurosurgical procedures extending for more than 4 hours. The study included 46 (27 males and 19 females) adult non-diabetic elective neurosurgical patients in AM grade I and II with mean age of 40±6.6 years. Patients were maintained on overnight fasting for 8 hours with no preoperative intravenous fluids administration and were randomly allocated into 2 equal groups: DNS/RL group received 500 ml of DNS and RL solutions alternately and R1/NS group received 500 ml of RL and 0.9% normal saline (NS) alternately. The study was terminated at the end of administration of two liters of fluid or if BCE decreased to <70 mg/d1. Fluids were administrated at rate of 3 mVkg/min and BGL was measured at preinduction and at the termination of each 500-ml of fluid. Intra-operative hypoglycemia was encountered in 3 patients (13%) in RI/NS group as their BCE decreased to <70 mg/di and was treated with DNS administration. Throughout the study period, BGL were significantly (P2>0.05) elevated in both groups compared to their pre-induction levels irrespective of the type of fluid administered. However, BGL in RUNS groups showed a progressive steadily elevation in each sample in comparison to the preceding one. In DNS/RL group, BCE estimated at the end of the 1" and 3^1 bottles (DNS solution) were significantly (131<0.005 & <0.001, respectively) higher compared to RI/NS group, while BCE estimated at the end of the 2^d and 4th bottles (RL solution) were significantly lower compared to levels estimated at the end administration of DNS solution with a non-significant difference compared to RI/NS group at the same time of estimation. In conclusion, administration of glucose in form of 5% dextrose in 0.9% saline alternatively with lactated ringer's solution starting prior to induction of anesthesia in patients assigned to have neurosurgical procedures extending for more than 4 hours modulates blood glucose levels within the acceptable limits while avoiding the risk of hyperor hypoglycemia.