Effect of Using Dextrose-containing Intraoperative Fluid in Children

NCT ID: NCT05061836

Last Updated: 2021-09-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

68 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-10-31

Study Completion Date

2022-12-31

Brief Summary

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The glucose-containing fluid was preferred for maintenance fluid in pediatric surgery to prevent hypoglycemic events. This practice can lead to intraoperative hyperglycemia which can induce osmotic diuresis and consequently dehydration and electrolyte disturbances.

As an anesthesiologist, the use of glucose-containing fluid should be reconsidered to avoid these undesirable effects in pediatric surgery.

Our study aims to identify an appropriate use of 5% dextrose containing solution during intraoperative period in children (2 age groups: 1-2 vs 3-5 years old) that can prevent glucose and lipid mobilization without causing hypo/hyperglycemia and provide adequate fluid maintenance in the context of hospitals in Thailand

Detailed Description

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* In this randomized controlled trial, the investigator will find the difference in pre and postoperative value of base excess among the different fluid groups which is an acid-base parameter indicating volume status and mobilization of lipid stores in each age group (2 age group: 1-2 vs 3-5 years old). Each age group will be divided to:

1. Group D0: patients will receive Acetate Ringer's solution (Acetar) infused at maintenance rate
2. Group D1: 5%dextrose in normal saline (5%DNSS) infused ¼ of maintenance rate \[resulted in 1.25%dextrose equivalence\]
3. Group D2: 5%DNSS infused ½ of maintenance rate \[resulted in 2.5%dextrose equivalence\]
4. Group D5: 5%DNSS infused with maintenance rate
* Patient will be fasting as standard preoperative fasting protocol, and received 5 ml/kg of water at 3 hours prior to surgery
* After standard anesthesia induction and intravenous line (IV) placement, the blood samples will be collected and the POCT glucose will be re-evaluated every 1 hour through the operation to avoid intraoperative hypo/hyperglycemia.
* The first blood sample will be collected after IV line placement and the second blood sample will be collected at the end of surgery. Both blood samples will be sent to the lab to measure blood glucose, serum electrolytes (sodium, potassium, and chloride), acid-base parameters (pH, base excess, standardized bicarbonate, anion gap), endocrine parameters (serum insulin, glucagon, cortisol), and metabolic parameters (free fatty acid, serum ketone, serum lactate).

Conditions

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Pediatric Surgery

Keywords

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Glucose containing solution Dextrose containing solution Dextrose-saline solution Pediatric fluid Pediatric hyperglycemia Pediatric hypoglycemia Intraoperative glucose Intraoperative fluid

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Dextrose0

Acetate Ringer's solution

Group Type EXPERIMENTAL

Ringer acetate

Intervention Type DRUG

Patient will receive Acetate Ringer's solution (Acetar) infused at maintenance rate

Dextrose1

1.25%dextrose equivalence

Group Type EXPERIMENTAL

1.25%Dextrose equivalence

Intervention Type DRUG

5%dextrose in normal saline (5%DNSS) infused ¼ of maintenance rate

Dextrose2

2.5%dextrose equivalence

Group Type EXPERIMENTAL

2.5%Dextrose equivalence

Intervention Type DRUG

5%dextrose in normal saline (5%DNSS) infused ½ of maintenance rate

Dextrose5

5%dextrose

Group Type ACTIVE_COMPARATOR

Dextrose 5

Intervention Type DRUG

5%dextrose in normal saline (5%DNSS) infused with maintenance rate

Interventions

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Ringer acetate

Patient will receive Acetate Ringer's solution (Acetar) infused at maintenance rate

Intervention Type DRUG

1.25%Dextrose equivalence

5%dextrose in normal saline (5%DNSS) infused ¼ of maintenance rate

Intervention Type DRUG

2.5%Dextrose equivalence

5%dextrose in normal saline (5%DNSS) infused ½ of maintenance rate

Intervention Type DRUG

Dextrose 5

5%dextrose in normal saline (5%DNSS) infused with maintenance rate

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Children aged of 1 to 5 years
2. ASA physical status 1 and 2
3. Schedule for elective non-abdominal surgery between 1-3 hours under general anesthesia without anticipation of major blood loss at Siriraj Hospital.

Exclusion Criteria

1. Patients with severe neurologic, cardiac, endocrine, or metabolic disease
2. Patients receiving intravenous fluid preoperatively
3. Patients with history or have known risk of hypoglycemia
4. Patient with severe liver dysfunction

Withdrawal or termination criteria

1. Patients requiring intraoperative blood product transfusion or inotropes infusion
2. Patients who have preoperative hypoglycemia
Minimum Eligible Age

1 Year

Maximum Eligible Age

5 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mahidol University

OTHER

Sponsor Role lead

Responsible Party

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patcharee sriswasdi

MD, MPH

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Siriraj Hospital

Bangkok Noi, Bangkok, Thailand

Site Status

Countries

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Thailand

Central Contacts

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Patcharee Sriswasdi, MD

Role: CONTACT

Phone: +66815500123

Email: [email protected]

References

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Nilsson K, Larsson LE, Andreasson S, Ekstrom-Jodal B. Blood-glucose concentrations during anaesthesia in children. Effects of starvation and perioperative fluid therapy. Br J Anaesth. 1984 Apr;56(4):375-9. doi: 10.1093/bja/56.4.375.

Reference Type BACKGROUND
PMID: 6712852 (View on PubMed)

Barua K, Rajan S, Paul J, Tosh P, Padmalayan A, Kumar L. Effect of Using Ringer's Lactate, with and without Addition of Dextrose, on Intra-Operative Blood Sugar Levels in Infants Undergoing Facial Cleft Surgeries. Anesth Essays Res. 2018 Apr-Jun;12(2):297-301. doi: 10.4103/aer.AER_53_18.

Reference Type BACKGROUND
PMID: 29962586 (View on PubMed)

Suraseranivongse S, Attachoo A, Leelanukrom R, Chareonsawan U, Horatanaruang D. National survey of pediatric anesthesia practice in Thailand. J Med Assoc Thai. 2011 Apr;94(4):450-6.

Reference Type BACKGROUND
PMID: 21591530 (View on PubMed)

Sieber FE, Smith DS, Traystman RJ, Wollman H. Glucose: a reevaluation of its intraoperative use. Anesthesiology. 1987 Jul;67(1):72-81. No abstract available.

Reference Type BACKGROUND
PMID: 3111308 (View on PubMed)

Lanier WL, Stangland KJ, Scheithauer BW, Milde JH, Michenfelder JD. The effects of dextrose infusion and head position on neurologic outcome after complete cerebral ischemia in primates: examination of a model. Anesthesiology. 1987 Jan;66(1):39-48. doi: 10.1097/00000542-198701000-00008.

Reference Type BACKGROUND
PMID: 3800033 (View on PubMed)

Nishina K, Mikawa K, Maekawa N, Asano M, Obara H. Effects of exogenous intravenous glucose on plasma glucose and lipid homeostasis in anesthetized infants. Anesthesiology. 1995 Aug;83(2):258-63. doi: 10.1097/00000542-199508000-00004.

Reference Type BACKGROUND
PMID: 7631946 (View on PubMed)

Sumpelmann R, Becke K, Crean P, Johr M, Lonnqvist PA, Strauss JM, Veyckemans F; German Scientific Working Group for Paediatric Anaesthesia. European consensus statement for intraoperative fluid therapy in children. Eur J Anaesthesiol. 2011 Sep;28(9):637-9. doi: 10.1097/EJA.0b013e3283446bb8.

Reference Type BACKGROUND
PMID: 21654319 (View on PubMed)

Datta PK, Pawar DK, Baidya DK, Maitra S, Aravindan A, Srinivas M, Lakshmy R, Gupta N, Bajpai M, Bhatnagar V, Agarwala S. Dextrose-containing intraoperative fluid in neonates: a randomized controlled trial. Paediatr Anaesth. 2016 Jun;26(6):599-607. doi: 10.1111/pan.12886. Epub 2016 Apr 16.

Reference Type BACKGROUND
PMID: 27083135 (View on PubMed)

HOLLIDAY MA, SEGAR WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957 May;19(5):823-32. No abstract available.

Reference Type BACKGROUND
PMID: 13431307 (View on PubMed)

Davis JW, Shackford SR, Mackersie RC, Hoyt DB. Base deficit as a guide to volume resuscitation. J Trauma. 1988 Oct;28(10):1464-7. doi: 10.1097/00005373-198810000-00010.

Reference Type BACKGROUND
PMID: 3172306 (View on PubMed)

Beath SV. Hepatic function and physiology in the newborn. Semin Neonatol. 2003 Oct;8(5):337-46. doi: 10.1016/S1084-2756(03)00066-6.

Reference Type BACKGROUND
PMID: 15001122 (View on PubMed)

Other Identifiers

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12345

Identifier Type: -

Identifier Source: org_study_id