BEBEKLERDE POSTOPERATİF HİPERGLİSEMİ, ASİDOZ, HİPOKSİ VE HİPOTERMİ

Abstract

Bebekler intraoperatif ve postoperatif hipotermi, hipoksi, asidoz, ve hiperglisemi riski altındadırlar. Bu komplikasyonların hepsi ayrı ayrı veya birlikte mortalite ve morbiditede etkili olabilmektedirler ve bunları hızla düzeltmek önem arzetmektedir. Bizim vakalarımızda intraoperatif hiperglisemi, hipoksi, asidoz ve hipotermisi oluşan 2 vaka incelendi. Operasyondan sonra yoğun bakımda takip edilen hastalar verilen tedavi sonrasında hızla düzeldiler. Herhangi bir sekel gözlenmedi. Sonuç olarak intraoperatif strese bağlı hiperglisemi oluşabilmektedir ve kan glukoz düzeylerinin takip edilmesi gerekmektedir. Erken kan glukoz regülasyonunun sağlanması olumlu prognoz açısından önemlidir. Hipoksi, hipotansiyon, asidoz ve hipotermi de hızla tedavi gerektiren sorunlardır. Anestezi altında özellikle uzun süren, vücüd boşluklarının açıldığı, fazla miktarda sıvı ve kan verilmesi gereken girişimlerde, daha dikkatli olunmalıdır.

Anahtar kelimeler: Postoperatif, infant, hiperglisemi, hipotermi, asidoz, hipoksi.

SUMMARY

Babies are at risk of hypothermia, hypoxia, acidosis and hyperglycemia at intraoperative and postoperative term. Since these complications can cause mortality and morbidity prompt intervention is important. In our report we present 2 cases who had intraoperative hyperglycemia, hypoxia, acidosis and hypothermia. They were followed in the intensive care unit and improved in a short time after appropriate therapy. No sequel was observed. Finally hyperglycemia can occur due to intraoperative stress and blood glucose levels should be monitored closely. Early blood glucose regulation is important for favorable prognosis. Hypoxia, hypotension, acidosis and hypothermia are also problems that need prompt intervention. One should be more careful in patients who had anesthesia for a long time, had open body cavity surgeries or received high amounts of fluid or blood during surgery.

Keywords: Postoperative, infant, hyperglycemia, hypotermia, acidosiz, hypoxemia.

Keywords

• Postoperatif
• infant
• hiperglisemi
• hipotermi
• asidoz
• hipoksi

BEBEKLERDE POSTOPERATİF HİPERGLİSEMİ, ASİDOZ, HİPOKSİ VE HİPOTERMİ

Abstract

Babies are at risk of hypothermia, hypoxia, acidosis and hyperglycemia at intraoperative and postoperative term. Since these complications can cause mortality and morbidity prompt intervention is important. In our report we present 2 cases who had intraoperative hyperglycemia, hypoxia, acidosis and hypothermia. They were followed in the intensive care unit and improved in a short time after appropriate therapy. No sequel was observed. Finally hyperglycemia can occur due to intraoperative stress and blood glucose levels should be monitored closely. Early blood glucose regulation is important for favorable prognosis. Hypoxia, hypotension, acidosis and hypothermia are also problems that need prompt intervention. One should be more careful in patients who had anesthesia for a long time, had open body cavity surgeries or received high amounts of fluid or blood during surgery.

Keywords

• Postoperative
• infant
• hyperglycemia
• hypotermia
• acidosiz
• hypoxemia

References

1. Srinavasan V, Spinella PC, Drott HR. Association of
2. Timing, Duration, and Intensity of Hyperglycemia
3. With Intensive Care Unit Mortality In Critically Ill
4. Children. Pediatr Crit Care Med 2004; 5:4.
5. Kanra G, Cengiz BA, Kara A, Melek E, Özön A.
6. Bakteriyel Menenjitli Bir Hastada Stres
7. Hiperglisemisi: Bir Vaka Takdimi. Çocuk Sağlığı ve
8. Hastalıkları Dergisi 2001; 44: 163-168.

9. Gupta P, Natarajan G, Agarwal KN. Transient
10. Hyperglycemia in Acute Childhood Illnesses to
11. Attend or Ignore? Indian J Pediatr. 1997; 64(2): 205-
12. E10s.p osito K, Marfella R, Gigliano D. Stress
13. Hyperglycemia, Inflammation and Cardiovasculer
14. Events. Diabetes Care 2003; 26: 1650-1.
15. Rabinowitz L, Joffe BI, Abkiewicz C, et al.
16. Hyperglycemia in Infantile Gastroenteritis. Arch Dis
17. Child 1984; 59: 771-775.
18. McCowen KC, Malhotra A, Bistrian BR. Stressinduced
19. Hyperglycemia. Crit Care Clin 2001; 17:
20. -124.
21. Wass CT, Lanier WL. Glucose Modulation of
22. İschemic Brain İnjury: Review and Clinical
23. Recommendations. Mayo Clin Proc 1996; 71:801-
24. -
25. Loepke AW, Spaeth JP. Glucose and Heart
26. Surgery: Neonates are not just Small Adults.
27. Anesthesiology 2004; 100:1339-1341.
28. Holliday M, Segar W. The maintenance Need for
29. Water in Parenteral Fluid Therapy. Pediatrics
30. ; 19:823-832.
31. Camboulives J. Fluid, Transfusion, and Blood
32. Sparing Techniques. Bissonnette BD, Dalens B,
33. Pediatric Anesthesia, Principles & Practice. New
34. York: McGraw-Hill; 2002. pp. 576-599.
35. Halberthal M, Halperin M, Bohn D. Acute
36. Hyponatremia in Children Admitted to Hospital:
37. Retrospective Analysis of Factors Contributing to
38. its Development and Resolution. BMJ 2001;
39. :780-782.
40. Arieff A, Ayus J, Fraser C. Hyponatraemia and
41. Death or Permanent Brain Damage in Healthy
42. Children. BMJ 1992; 304:1218-1222.
43. Arieff AI. Postoperative Hyponatraemic
44. Encephalopathy Following Elective Surgery in
45. Children. Paediatr Anaesth 1998; 8:1-4.
46. Paut O, Remond C, Lagier P, et al. Severe
47. Hyponatrenic Encephalopathy After Pediatric
48. Surgery: Report of Seven Cases And
49. Recommendations for Management And
50. Prevention Ann Fr Anesth Reanim 2000; 19:467-
51. -
52. Bohn D. Children are Another Group at Risk of
53. Hyponatraemia Perioperatively. BMJ 1999;
54. :1269.
55. Spaeth JP. Glucose and Heart surgery: Neonates
56. are not just Small Adults. Anesthesiology 2004;
57. :1339-1341.
58. Welborn LG, McGill WA, Hannallah RS, et al.
59. Perioperative Blood Glucose Concentrations in
60. Pediatric Outpatients. Anesthesiology 1986; 65:543-
61. -
62. Sandstro¨m K, Larsson LE, Nilsson K. Four
63. Different Fluid Regimes During and after Minor
64. Pediatric Surgery—a Study of Blood Glucose
65. Concentrations. Paediatr Anaesth 1994; 4:235-242.
66. Hongnat JM, Murat I, Saint-Maurice C.
67. Evaluation of current Pediatric Guidelines for
68. Fluid Therapy Using Two Different Dextrose
69. Hydrating Solutions. Paediatr Anaesth 1991; 1:95-
70. -
71. de Ferranti S, Gauvreau K, Hickey PR, et al.
72. Intraoperative Hyperglycemia During Infant
73. Cardiac Surgery is not Associated with Adverse
74. Neurodevelopmental Outcomes at 1, 4, and 8
75. Years. Anesthesiology 2004; 100:1345-1352.
76. Mikawa K, Maekawa N, Goto R, et al. Effects of
77. Exogenous Intravenous Glucose on Plasma
78. Glucose and Lipid Homeostasis in Anesthetized
79. Children. Anesthesiology 1991; 74:1017-1022
80. Larsson LE, Nilsson K, Niklasson A, et al. Influence
81. of Fluid Regimens on Perioperative blood-glucose
82. Concentrations in Neonates. Br J Anaesth 1990;
83. :419-424.
84. Nishina K, Mikawa K, Maekawa N, et al. Effects of
85. Exogenous Intravenous Glucose on Plasma
86. Glucose and Lipid Homeostasis in Anesthetized
87. Infants. Anesthesiology 1995; 83:258 263.