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The effect of thoracic extradural analgesia and vagal blockade on the metabolic and endocrine responses to cholecystectomy was investigated. In comparison with a control group of patients, extradural analgesia and vagal blockade abolished the glycaemic response but had no effect on the increase in plasma cortisol. Circulating insulin values were significantly decreased in the extradural group of patients, confirming the importance of autonomic innervation in maintaining basal insulin output. there is, at present, no satisfactory local analgesic technique for controlling the endocrine response to upper abdominal surgery.

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The effects of infusion i.v. of 0.9% sodium chloride solution, Hartmann's and 5% dextrose solution on the concentrations of circulating metabolites and insulin were compared in patients undergoing cholecystectomy. Hartmann's solution had a similar effect on the metabolic response to 0.9% sodium chloride solution, but the use of 5% dextrose was associated with an exacerbation of the hyperglycaemic response to surgery. Plasma insulin concentrations increased significantly in the group receiving 5% dextrose showing that the usual suppression of insulin during abdominal surgery can be overcome by a strong glycaemic stimulus.

1. Changes in liver glycogen and glycolytic intermediates were determined in ten patients undergoing abdominal surgery for carcinoma of the colon. 2. One hour of surgery resulted in a 19% decrease in liver glycogen, together with an increase in hepatic glucose 6-phosphate and glucose concentrations. 3. Blood glucose increased from 5.01 to 6.67 mmol/l during the hour between liver biopsies. 4. We conclude that the hyperglycaemia of surgery is associated with stimulation of hepatic glycogenolysis.