Abstract
We studied the influence of prolonged anaesthesia and surgery on glucose metabolism by means of the euglycaemic insulin clamp method in eight patients who underwent prolonged surgery. Eleven patients who underwent surgery of short duration served as a control group. Plasma concentrations of catabolic hormones were measured simultaneously. Glucose utilization during prolonged anaesthesia, (PA) group, was lower than that in the control group (P < 0.01) (glucose utilization 7.59 ± 0.73 mg · kg−1 · hr−1 in the control group vs 4.03 ± 0.71 mg · kg−1 hr−1 in PA group respectively). There were no significant differences in plasma catecholamine and glucagon concentrations between the PA and control groups. Plasma-free fatty acid levels increased significantly in the PA group before the euglycaemic insulin clamp (free fatty acid level: 0.496 ± 0.053 mmol·L−1 in the control group, vs 0.834 ± 0.103 mmol·L−1 in the PA group at the pre-clamp period, P < 0.01). Tissue resistance to exogenous insulin increased during prolonged anaesthesia and surgery although there were no significant changes in plasma catabolic hormone levels.
Résumé
On a étudié l’influence de l’anesthésie prolongée et la chirurgie sur le métabolisme du glucose en utilisant le lest «Euglycaemic insulin clamp method» chez huit patients devant subir une chirurgie prolongée. Onze patients devant subir une chirurgie de courte durée ont servi comme groupe contrôle. Les concentrations plasmatiques des hormones de catabolisme ont été mesurées simultanément. l’utilisation du glucose durant l’anesthésie prolongée (PA), dans le groupe PA, était plus basse que celle du groupe contrôle (P < 0.01) (l’utilisation du glucose 7,59 ± 0,73 mg · kg−1 · hre−1 pour le groupe contrôle versus 4,03 ± 0,71 mg · kg−1 · hre−1 dans le groupe PA). Il n’y avail aucune différence significative dans les catécholamines plasmatiques et les contractions de glucagon entre le groupe PA et le groupe contrôle. Le taux d’acide gras plasmatique libre a augmenté significativement dans le groupe PA avant le test de «Eu glycaemic insulin clamp» (taux d’acide gras libre: 0,496 ± 0,053 mmol · L−1 pour le groupe contrôle versus 0,834 ± 0.103 mmol · L−1 dans le groupe PA pour la période pré-clampage, P < 0,01). La résistance tissulaire à l’insuline exogène a augmenté durant l’anesthésie prolongée et la chirurgie même s’il n’y avait aucun changement significatif dans le niveau des hormones de catabolisme.
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Tsubo, T., Kudo, T., Matsuki, A. et al. Decreased glucose utilization during prolonged anaesthesia and surgery. Can J Anaesth 37, 645–649 (1990). https://doi.org/10.1007/BF03006483
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DOI: https://doi.org/10.1007/BF03006483