Postoperative Deterioration in Muscular Function

Edwards, Hannibal

doi:10.1001/archsurg.1982.01380310021005

“…Major surgery elicits a metabolic stress response with loss of body mass, fatigue [1,2,3] and impaired physical performance [1, 3, 4], including a reduced work capacity [3,5,6,7]. Several factors may be involved, including the hemodynamic and hormonal responses to surgery [4], blood loss [8,9,10], bed rest [11,12,13] and fasting [14].…”

Section: Introductionmentioning

confidence: 99%

Effect of Darbepoetin Alfa on Physical Function in Patients Undergoing Surgery for Colorectal Cancer

Nørager

¹

,

Jensen

²

,

Madsen

³

et al. 2006

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Objective: To study whether perioperative treatment with darbepoetin alfa (DA) improves physical performance following colorectal cancer surgery. Methods: Patients admitted for planned colorectal cancer surgery were randomized to receive either weekly placebo or DA 300 or 150 µg depending on the hemoglobin (Hb) concentration. Patients were assessed 10 days before, as well as 7 and 30 days after surgery for work capacity, postural sway, muscle strength, fatigue and quality of life (QoL). The primary outcome measure were the changes in patients’ physical performance from preoperative to postoperative day 7. Results: Of 221 included patients, 151 were evaluable. Baseline characteristics were similar in the 2 groups. Patients receiving DA had a significantly better working capacity on day 7 (p = 0.03) and day 30 (p = 0.03) compared with the placebo group. There were no statistically significant differences between the 2 groups on days 7 or 30 for fatigue, postural sway and QoL. DA treatment significantly (p < 0.01) reduced the decrease in Hb concentrations on day 7 and resulted in an earlier return (p < 0.01) to the preoperative Hb concentration compared to placebo treatment. Conclusion: Perioperative DA treatment improved postoperative work capacity and Hb concentrations, but had no effect on postoperative fatigue, postural sway, QoL and muscle strength.

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“…Since the sarcoplasmic reticulum is important for Ca# + handling, it has been suggested as a factor underlying the decrease in force-generating capacity during prolonged exercise [30]. Similarly, the decreased insulin-induced glycogenesis in the muscle in post-operative insulinresistant patients [31] may provide an additional explanation for the reduced force-generating capacity of muscle reported in the post-operative phase (see [12,13,15]). …”

Section: Discussionmentioning

confidence: 99%

“…The increased catabolism of proteins in the post-operative phase can, at least theoretically, be explained by the increase in insulin resistance, since insulin inhibits protein degradation [4,10,11]. After surgery, insulin resistance is present, as is reduced muscle function, which may be related to proteolysis [2][3][4][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Post-operative effects on insulin resistance and specific tension of single human skeletal muscle fibres

DEGENS¹,

Soop²,

HÖÖK³

et al. 1999

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Surgery and accidental trauma are associated with a transient period of insulin resistance, substrate catabolism and muscle weakness. In the present study, we evaluated the changes in the force-generating capacity of chemically skinned single muscle fibres following abdominal surgery. Biopsies of the m. vastus lateralis were obtained in three patients 1 day before and 3 or 6 days after surgery. Part of the biopsy was frozen for histochemical analysis of the fibre cross-sectional area (FCSA) and myofibrillar protein content, and another part was used for single-fibre contractile measurements. All patients developed insulin resistance following surgery. The maximum velocity of unloaded shortening of single muscle fibres did not change following surgery. The FCSA did not decrease after surgery, as determined either from histochemical sections or from single fibres measured at a fixed sarcomere length of 2.76+/-0.09 microm (mean+/-S.D.). Further, the force-generating capacity of the single fibres, measured as maximal Ca(2+)-activated force (P(0)) or as P(0) normalized to FCSA (specific tension), remained unchanged, as did the myofibrillar protein content of the muscle. In conclusion, the muscle weakness associated with post-operative insulin resistance is not related to a decreased specific tension or a loss of myofibrillar proteins. Other potential cellular mechanisms underlying post-operative weakness are discussed.

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“…However, increased insulin resistance has been reported to develop after abdominal surgery, despite the presence of normal levels of stress hormones, indicating that other factors also initiate this part of the stress response [7]. After surgery, insulin resistance is present, as is reduced muscle function, which may be related to proteolysis [2][3][4][12][13][14][15]. After surgery, insulin resistance is present, as is reduced muscle function, which may be related to proteolysis [2][3][4][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Post-operative effects on insulin resistance and specific tension of single human skeletal muscle fibres

Degens

¹

,

Soop

²

,

Höök

³

et al. 1999

View full text Add to dashboard Cite

Surgery and accidental trauma are associated with a transient period of insulin resistance, substrate catabolism and muscle weakness. In the present study, we evaluated the changes in the force-generating capacity of chemically skinned single muscle fibres following abdominal surgery. Biopsies of the m. vastus lateralis were obtained in three patients 1 day before and 3 or 6 days after surgery. Part of the biopsy was frozen for histochemical analysis of the fibre cross-sectional area (FCSA) and myofibrillar protein content, and another part was used for single-fibre contractile measurements. All patients developed insulin resistance following surgery. The maximum velocity of unloaded shortening of single muscle fibres did not change following surgery. The FCSA did not decrease after surgery, as determined either from histochemical sections or from single fibres measured at a fixed sarcomere length of 2.76+/-0.09 microm (mean+/-S.D.). Further, the force-generating capacity of the single fibres, measured as maximal Ca(2+)-activated force (P(0)) or as P(0) normalized to FCSA (specific tension), remained unchanged, as did the myofibrillar protein content of the muscle. In conclusion, the muscle weakness associated with post-operative insulin resistance is not related to a decreased specific tension or a loss of myofibrillar proteins. Other potential cellular mechanisms underlying post-operative weakness are discussed.

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Postoperative Deterioration in Muscular Function

Cited by 43 publications

References 7 publications

Effect of Darbepoetin Alfa on Physical Function in Patients Undergoing Surgery for Colorectal Cancer

Effect of Darbepoetin Alfa on Physical Function in Patients Undergoing Surgery for Colorectal Cancer

Post-operative effects on insulin resistance and specific tension of single human skeletal muscle fibres

Post-operative effects on insulin resistance and specific tension of single human skeletal muscle fibres

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