METABOLIC ASPECTS OF DEEP SURGICAL HYPOTHERMIA IN INFANCY

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Abstract
Aspects of carbohydrate and lipid metabolism were examined in 10 infants whose core temperatures were lowered by external cooling to 15 to 20°C during cardiovascular surgery. Modest hyperglycemia, found with ether anesthesia, persisted in three patients not given glucose, but it was markedly increased in others given glucose infusions. Despite continued glucose infusion, plasma glucose returned toward prehypothermic levels with rewarming, provided epinephrine was not administered. When epinephrine was given, the return was slowed. These observations suggest diminished glucose utilization during hypothermia and arouse speculation concerning a related insulin abnormality. In general, plasma lactate and glycerol levels increased during hypothermia, reaching a peak after circulatory arrest and with rewarming. Plasma free fatty acid concentrations changed little until rewarming when they usually became depressed. Death occurred in all five infants in whom plasma glycerol and lactate levels were rising at the procedure's end, while plasma glycerol and lactate concentrations were falling on completion of the operation in patients who did well. These findings and the known importance of the liver in lactate and glycerol metabolism suggest that the course of plasma lactate and glycerol levels may prove useful as a reflection of hepatic dysfunction in patients undergoing hypothermic surgery.

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