Risk factors for intraoperative hypoglycemia in children: a retrospective observational cohort study
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REPORTS OF ORIGINAL INVESTIGATIONS
Risk factors for intraoperative hypoglycemia in children: a retrospective observational cohort study Facteurs de risque d’hypoglyce´mie perope´ratoire chez l’enfant : une e´tude de cohorte observationnelle re´trospective . Aleda M. Leis, MS . Shobha Malviya, MD . Lori Q. Riegger, MD Kevin K. Tremper, PhD, MD Received: 25 April 2019 / Revised: 11 July 2019 / Accepted: 22 July 2019 Ó Canadian Anesthesiologists’ Society 2019
Abstract Purpose Intraoperative hypoglycemia can result in devastating neurologic injury if not promptly diagnosed and treated. Few studies have defined risk factors for intraoperative hypoglycemia. The authors sought to characterize children with intraoperative hypoglycemia and determine independent risk factors. Methods This retrospective observational singleinstitution study included all patients \ 18 yr of age undergoing an anesthetic from January 1 2012 to December 31 2016. The primary outcome was blood glucose \ 3.3 mmolL-1 (60 mgdl-1). Data collected included patient characteristics, comorbidities, and intraoperative factors. A multivariable logistic regression model was used to identify independent predictors of intraoperative hypoglycemia. Results Blood glucose was measured in 7,715 of 73,592 cases with 271 (3.5%) having a glucose \ 3.3 mmolL-1 (60 mgdl-1). Young age, weight for age \ 5th percentile, developmental delay, presence of a gastric or jejunal tube, and abdominal surgery were identified as independent predictors for intraoperative hypoglycemia. Eighty percent of hypoglycemia cases occurred in children \ three years of age and in children \ 15 kg. Conclusion Young age, weight for age \ 5th percentile, developmental delay, having a gastric or jejunal tube, and abdominal surgery were independent risk factors for intraoperative hypoglycemia in children. Frequent
L. Q. Riegger, MD (&) A. M. Leis, MS S. Malviya, MD K. K. Tremper, PhD, MD Department of Anesthesiology, University of Michigan Health System, 4-911 Mott Hospital SPC 4245, 1540 E. Hospital Dr, Ann Arbor, MI 48109-4245, USA e-mail: [email protected]
monitoring of blood glucose and judicious isotonic dextrose administration may be warranted in these children. Re´sume´ Objectif L’hypoglyce´mie perope´ratoire peut entraıˆner des le´sions neurologiques catastrophiques si elle n’est pas diagnostique´e et traite´e rapidement. Tre`s peu d’e´tudes ont de´fini les facteurs de risque d’hypoglyce´mie perope´ratoire. Les auteurs ont essaye´ de caracte´riser les enfants atteints d’hypoglyce´mie perope´ratoire et de de´terminer les facteurs de risque inde´pendants. Me´thode Cette e´tude observationnelle re´trospective monocentrique a inclus tous les patients \ 18 ans subissant une anesthe´sie entre le 1er janvier 2012 et le 31 de´cembre 2016. Le crite`re d’e´valuation principal e´tait une glyce´mie \ 3,3 mmolL-1 (60 mgdl-1). Les donne´es collige´es comprenaient les caracte´ristiques des patients, les comorbidite´s et les facteurs perope´ratoires. Un mode`le de re´gression logistique multi
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