Przedoperacyjna doustna podaż roztworu węglowodanów u dzieci — ocena tolerancji i odpowiedzi metabolicznej — doniesienie wstępne

Background: The need for long preoperative fasting has been questioned. Recent data shows that intake of oral carbohydrate-containing clear fluid prior to anaesthesia is safe and may have positive impact on recovery, metabolic status and improve glucose tolerance. Such solutions are routinely used in adults but not children. The aim of this study was to evaluate safety, tolerance and influence of oral carbohydrate on selected metabolic parameters in children.Methods: With the ethics committee approval and parental informed consent 20 children, aged 4–17 years, ASA status I or II, scheduled for abdominal or thoracic surgery were randomized to group 1 — receiving a 12.6% carbohydrate-containing drink (10 mL kg-1 the evening before surgery and 2 hours before anaesthesia) or control group 2 — fasting. Serum glucose and insulin concentration were measured four times: before and after anaesthesia, in the evening after surgery and the following morning. IGF-1 concentration was measured once, before surgery. Insulin resistance was assessed by the HOMA-IR equation.Results: Oral carbohydrate solution was well tolerated and no adverse events were noted. Glucose concentrations were within the normal range in both groups. Insulin concentration did not show significant differences between groups, however before surgery it tended to be lower in group 1. Insulin resistance after surgery was significantly higher in group 2 (2.0 vs. 0.62, P = 0.03), also the increase in insulin resistance after operation was significant only in control group (P = 0.03).Conclusion: Oral carbohydrates were safe, well tolerated and did not cause any perioperative adverse events. They seem to improve postoperative metabolism by decreasing insulin resistance.Background: The need for long preoperative fasting has been questioned. Recent data shows that intake of oral carbohydrate-containing clear fluid prior to anaesthesia is safe and may have positive impact on recovery, metabolic status and improve glucose tolerance. Such solutions are routinely used in adults but not children. The aim of this study was to evaluate safety, tolerance and influence of oral carbohydrate on selected metabolic parameters in children.Methods: With the ethics committee approval and parental informed consent 20 children, aged 4–17 years, ASA status I or II, scheduled for abdominal or thoracic surgery were randomized to group 1 — receiving a 12.6% carbohydrate-containing drink (10 mL kg-1 the evening before surgery and 2 hours before anaesthesia) or control group 2 — fasting. Serum glucose and insulin concentration were measured four times: before and after anaesthesia, in the evening after surgery and the following morning. IGF-1 concentration was measured once, before surgery. Insulin resistance was assessed by the HOMA-IR equation.Results: Oral carbohydrate solution was well tolerated and no adverse events were noted. Glucose concentrations were within the normal range in both groups. Insulin concentration did not show significant differences between groups, however before surgery it tended to be lower in group 1. Insulin resistance after surgery was significantly higher in group 2 (2.0 vs. 0.62, P = 0.03), also the increase in insulin resistance after operation was significant only in control group (P = 0.03).Conclusion: Oral carbohydrates were safe, well tolerated and did not cause any perioperative adverse events. They seem to improve postoperative metabolism by decreasing insulin resistance

Neurogenic stunned myocardium — do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure?

Neurogenic stunned myocardium (NSM) is defined as myocardial injury and dysfunction of a sudden onset, occurring after various types of acute brain injury as a result of an imbalance in the autonomic nervous system. The typical spectrum of clinically observed abnormalities includes acute left ventricular failure, not uncommonly progressing to cardiogenic shock with hypotension that requires inotropic agents, pulmonary oedema and various arrhythmias. Commonly-seen electrocardiographic changes include: prolonged QT interval, ST segment changes, T-wave inversion, a new Q-wave or U-wave. Echocardiography shows an impaired both systolic and diastolic function of the left ventricle. Biochemical markers of NSM comprise metabolic acidosis and increased cardiac enzymes and markers: creatine kinase (CK), and CK-MB, troponin I and B-type natriuretic peptide. The main cause of NSM is myocardial injury induced by local catecholamine release from nerve endings within the myocardium. Recently, a theory has been proposed to classify NSM as one of the stress-related cardiomyopathies, together with Takotsubo cardiomyopathy, acute left ventricular failure in the critically ill, cardiomyopathy associated with pheochromacytoma and exogenous catecholamine administration. The occurrence of NSM increases the risk of life-threatening complications, death, and worsens neurologic outcome. As far as we know, treatment should generally focus on the underlying neurologic process in order to maximize neurologic recovery. Improvement in neurologic pathology leads to rapid improvement in cardiac function and its full recovery, as NSM is a fully reversible condition if the patient survives. Awareness of the existence of NSM and a deeper knowledge of its etiopathology may reduce diagnostic errors, optimise its treatment.Neurogenic stunned myocardium (NSM) is defined as myocardial injury and dysfunction of a sudden onset, occurring after various types of acute brain injury as a result of an imbalance in the autonomic nervous system. The typical spectrum of clinically observed abnormalities includes acute left ventricular failure, not uncommonly progressing to cardiogenic shock with hypotension that requires inotropic agents, pulmonary oedema and various arrhythmias. Commonly-seen electrocardiographic changes include: prolonged QT interval, ST segment changes, T-wave inversion, a new Q-wave or U-wave. Echocardiography shows both an impaired both systolic and diastolic function of the left ventricle. Biochemical markers of NSM comprise metabolic acidosis and increased cardiac enzymes and markers: creatine kinase (CK), and CK-MB, troponin I and B-type natriuretic peptide. The main cause of NSM is myocardial injury induced by local catecholamine release from nerve endings within the myocardium. Recently, a theory has been proposed to classify NSM as one of the stress-related cardiomyopathies, together with Takotsubo cardiomyopathy, acute left ventricular failure in the critically ill, cardiomyopathy associated with pheochromacytoma and exogenous catecholamine administration. The occurrence of NSM increases the risk of life-threatening complications, death, and worsens neurologic outcome. As far as we know, treatment should generally focus on the underlying neurologic process in order to maximize neurologic recovery. Improvement in neurologic pathology leads to rapid improvement in cardiac function and its full recovery, as NSM is a fully reversible condition if the patient survives. Awareness of the existence of NSM and a deeper knowledge of its etiopathology may reduce diagnostic errors, optimise its treatment

Zasady leczenia żywieniowego na oddziałach intensywnej terapii dziecięcej. Wspólne stanowisko towarzystw naukowych: Sekcji Anestezji i Intensywnej Terapii Dziecięcej PTAiIT, PTN, PTŻKD

Providing nutritional therapy via the gastrointestinal tract in patients in paediatric intensive care units (PICUs) is an effective method for delivering energy and other nutrients. In the event of contraindications to using this method, it is necessary to commence parenteral nutrition. In the present study, methods for nutritional treatments in critically ill children are presented, depending on the clinical situation.Providing nutritional therapy via the gastrointestinal tract in patients in paediatric intensive care units (PICUs) is an effective method for delivering energy and other nutrients. In the event of contraindications to using this method, it is necessary to commence parenteral nutrition. In the present study, methods for nutritional treatments in critically ill children are presented, depending on the clinical situation