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Anesth Analg 2009; 108:81-89
© 2009 International Anesthesia Research Society
doi: 10.1213/ane.0b013e31818a6f32
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PEDIATRIC ANESTHESIOLOGY

Incidence and Risk Factors for Perioperative Hyperglycemia in Children with Traumatic Brain Injury

Deepak Sharma, MD, DM*, Jill Jelacic, MD*, Rohini Chennuri, MD*, Onuma Chaiwat, MD*||, Wayne Chandler, MD{ddagger}, and Monica S. Vavilala, MD*{dagger}||§

From the *Department of Anesthesiology, {dagger}Harborview Injury Prevention and Research Center, Departments of {ddagger}Laboratory Medicine, §Pediatrics and Neurological Surgery, and ||Harborview Anesthesia Research Center, University of Washington, Seattle, Washington.

Address correspondence to Monica S. Vavilala, MD, Department of Anesthesiology, Harborview Medical Center, 325 Ninth Ave., Box 359724, Seattle, WA 98104. Address e-mail to vavilala{at}u.washington.edu.

Abstract

BACKGROUND: Hyperglycemia after traumatic brain injury (TBI) is associated with poor outcome. In this study, we examined the incidence and risk factors for perioperative hyperglycemia in children with TBI.

METHODS: A retrospective cohort study of children ≤13 yr who underwent urgent or emergent craniotomy for TBI at Harborview Medical Center (level I Adult and Pediatric Trauma Center) between 1994 and 2004 was performed. Preoperative (emergency department to general anesthesia start), intraoperative (during general anesthesia), and immediate postoperative (first 24 h after surgery) glucose values for each patient were retrieved. The incidence of hyperglycemia (glucose ≥200 mg/dL) and hypoglycemia (glucose <60 mg/dL) was determined. Persistent hyperglycemia was defined as hyperglycemia during any 2/3 (preoperative, intraoperative, and immediate postoperative) study periods, whereas transient hyperglycemia was defined as hyperglycemia during any one study period. Multivariate logistic regression analysis was used to determine the independent predictors of perioperative hyperglycemia. Data are presented as adjusted odds ratio (AOR) (95% CI) and P < 0.05 reflects significance.

RESULTS: At least one serum glucose value was recorded during each study period: preoperative (86 [82%]), intraoperative (94 [89%]), and postoperative (101 [97%]). Sixty-four percent of children had less than one glucose recorded per anesthetic hour. Forty-seven (45%) children had hyperglycemia during at least one study period. Transient hyperglycemia occurred in 29 (28%) and persistent hyperglycemia occurred in 18 (17%) children. Independent predictors of perioperative hyperglycemia were age <4 yr (AOR [95% CI]; 3.5 [1.2-10.6]), Glasgow Coma Scale ≤8 (AOR 95% CI; 7.2 [2.4-21.5]) and the presence of multiple lesions including subdural hematoma (AOR 95% CI; 34.7 [2.3-525.5]). Six children were treated with insulin, and two children had hypoglycemia, unrelated to insulin treatment.

CONCLUSIONS: Perioperative hyperglycemia was common and intraoperative hypoglycemia was not rare, but more frequent intraoperative glucose sampling may be needed to better determine the incidence of hypo and hyperglycemia during the perioperative period. Age <4 yr, severe TBI and the presence of multiple lesions, including subdural hematoma, were risk factors for perioperative hyperglycemia.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2009 by the International Anesthesia Research Society.