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.

Summary

A reproducible technique was developed experimentally in pigs for construction of a 'composite bowel tube' (CBT) made up of ileal mucosa that was grafted to a mucosally denuded colonic muscle surface vascularised by the colonic mesentery. Macroscopic and microscopic studies at terminal laparotomy revealed a viable, mucosally lined, patent peristaltic loop of bowel in six of the eight animals. Two animals died after sloughing the grafted mucosa. In vivo absorption studies, using l-alanine as an index of amino acid absorption, showed a transport pattern through the grafted mucosa of the composite ileo-colic loop appropriate to ileum when compared with controls. The CBT constitutes another autologous gastro-intestinal reconstructive technique for redistribution of available absorptive mucosa over a longer intestinal length, and may therefore be of benefit in the management of the short-bowel syndrome.

SummaryThe metabolic and hormonal response to laparoscopy was investigated in 22 Key wordsSurgery; laparoscopy. Metabolism.Laparoscopy is now a very common procedure, particularly in gynaecology. It is often assumed, both by the surgeon and the patient, that it is a minor event. This may be due to many factors including the small skin incision, the short duration of the procedure and its use as an investigative tool particularly on a daycase basis.The present study was undertaken to provide an objective assessment of the stress of laparoscopy by determining the hormonal and metabolic response to the procedure. In addition, supplementation of a nitrous oxide-oxygen anaesthetic technique with either 150 pg fentanyl or an Althesin infusion on the hormonal and metabolic changes was compared. MethodsTwenty-two young healthy women who were admitted for laparoscopy for either the investigation of infertility or sterilisation, were studied. They were randomly allocated to receive supplementation of their anaesthetic with either fentanyl 150 pg or an Althesin (alphaxalonealphadolone acetate, Glaxo Group Ltd.) infusion. The nature of the study was explained to each patient and her consent obtained for central venous blood sampling. Approval for the study was obtained from the Hospital Ethical Committee. All the patients were operated on by one oftwo gynaecologists, at the same time of day.

SUMMARYThe effects of ketamine anaesthesia on the metabolic and endocrine response to pelvic surgery were investigated, and compared with results obtained in a control group of patients anaesthetized with thiopentone and halo thane. Ketamine anaesthesia before the onset of surgery was associated with a significant increase in blood glucose and plasma cortisol concentrations, and in heart rate. However, when surgery was established there were no metabolic, endocrine or haemodynamic differences between ketamine and halothane anaesthesia. We conclude that ketamine does not exacerbate the metabolic response to surgery.Although the cardiovascular effects of ketamine anaesthesia have been studied in detail (for review see White, Way and Trevor, 1982), little attention has been directed towards the associated endocrine and metabolic changes. Since it has been shown that ketamine causes an increase in circulating catecholamine (Takki et al., 1972;Baraka, Harrison and Kachachi, 1973; Appeletal., 1979), ACTHand cortisol concentrations (Oyama, Matsumoto and Kudo, 1970), it could be argued that the use of this agent may exacerbate the metabolic response to surgery.Clarke and colleagues (1974) found that ketamine anaesthesia was associated with slightly higher blood glucose and plasma cortisol concentrations, when compared with other induction agents in patients who had undergone minor gynaecological surgery. In contrast, Kaniaris and co-workers (1975) demonstrated a decreased glucose and nonesterified fatty acid (NEFA) response to surgery with ketamine anaesthesia compared with halothane and thiopentone in children. In a recent study by Stefansson, Wickstrom and Haljamae (1982a) ketamine anaesthesia was used in elderly patients undergoing surgical correction of fractured neck of femur and changes in circulating and intramuscular metabolites were measured. Unfortunately, a direct comparison of these metabolic results with similar patients anaesthetized with other techniques was not possible because of differences in the preoperative blood glucose concentration (Stefansson, Wickstrom and Haljamae, 1982b, c).In the present study we have attempted to resolve these conflicting reports by examining the effects of ketamine anaesthesia on the concentrations of circulating metabolites, and cortisol, during pelvic surgery. PATIENTS AND METHODSSixteen healthy women admitted for Fallopian tubal surgery were investigated. On admission to hospital their height and body weight were recorded and the body mass index calculated as an estimate of adiposity (Keys, Fidanza and Karvonen, 1972). The patients were allocated randomly to receive supplementation of anaesthesia either with an infusion of ketamine, or with halothane. The nature of the study was explained to the patients and consent obtained for the collection of samples of central venous blood.All patients were premedicated with papaveretum 15-20mg and hyoscineO.3-0.4mgi.m. 90min before surgery. On arrival in the anaesthetic room the duration of starvation was determined and a centr...