Postoperative insulin secretion is decreased in patients with preoperative insulin resistance

Donatelli, Francesco; Nafi, Matteo; Pietropaoli, Lina; Nicola, Marta Di; Piva, Ilaria; Gillis, Chelsia; Selladurai, Sashika; Marinangeli, Franco; Carli, Francesco

doi:10.1111/aas.13248

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…20 Postoperative alterations in glycemic profile are probably caused by a combination of reduced peripheral insulin sensitivity and a decreased production of insulin. 2,25 In addition, hyperglycemia itself may exacerbate the stress-conditioned catabolic changes as pro-inflammatory cytokines and products of reactive oxygen species decrease after resolution of hyperglycemia by insulin infusion. 26 One hyperinsulinaemic clamp study showed that glycemic oscillations cause more endothelial damage than constant high p-glucose, 27 and it could be hypothesized that high glycemic variability itself is more deleterious on recovery than stable hyperglycemia.…”

Section: Discussionmentioning

confidence: 99%

“…The surgical stress response induces a systemic catabolic inflammatory state with subsequent hormonal imbalance and altered cytokine production 20 . Postoperative alterations in glycemic profile are probably caused by a combination of reduced peripheral insulin sensitivity and a decreased production of insulin 2,25 . In addition, hyperglycemia itself may exacerbate the stress‐conditioned catabolic changes as pro‐inflammatory cytokines and products of reactive oxygen species decrease after resolution of hyperglycemia by insulin infusion 26 .…”

Section: Discussionmentioning

confidence: 99%

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Glycemic profile and quality of recovery after emergency abdominal surgery–A prospective explorative cohort study

Andersen

Priergaard

Banke

et al. 2023

Acta Anaesthesiol Scand

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Associations between degrees of postoperative hyperglycemia and morbidity has previously been established. There may be an association between the glycemic profile and patient‐reported recovery, and this may be a target for perioperative quality improvements. We aimed to investigate the association between metrics of the 30‐day glycemic profile and patient‐reported recovery in nondiabetic patients after major abdominal surgery. In a prospective, explorative cohort study, nondiabetic adult patients undergoing acute, major abdominal surgery were included within 24 h after surgery. Interstitial fluid glucose concentration was measured for 30 consecutive days with a continuous glucose measurement device. The validated questionnaire ‘Quality of Recovery‐15’ was used to assess patient‐reported quality of recovery on postoperative days 10, 20, and 30. Follow‐up time was divided into five‐day postoperative intervals using days 26–30 as a reference. Linear mixed models were applied to investigate temporal changes in mean p‐glucose, coefficient of variation, time within 70–140 mg/dl, and time above 200 mg/dl in relation to patient‐reported recovery. Twenty‐seven patients completed the study per protocol. A hyperglycemic event (>200 mg/dl) occurred in 18 of 27 patients (67%) within the first three postoperative days. Compared to the reference period, the coefficient of variation was significantly increased during all time intervals, indicating prolonged postoperative insulin resistance. During 30 days of follow‐up, patient‐reported recovery was associated with the coefficient of variation measured for 3 and 5 days before the corresponding recovery score assessment (recovery score estimate −1.52 [p < .001] and −0.92 [p = .006], respectively). We did not find an association between the remaining metrics and patient‐reported recovery. Alterations in the glycemic profile are frequent and prolonged during the first postoperative month after major surgery probably due to peripheral insulin resistance. Our findings indicate that high‐glycemic variation is associated with poorer patient‐reported recovery and might represent a proxy for care improvements in the postoperative period.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Glycemic profile and quality of recovery after emergency abdominal surgery–A prospective explorative cohort study

Andersen

Priergaard

Banke

et al. 2023

Acta Anaesthesiol Scand

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“…For diabetic patients, the safety concerns of using glucocorticoids mainly lie in incision infection and postoperative hyperglycemia. Good postoperative analgesia is helpful to stabilize postoperative blood glucose fluctuations and counteract the elevated blood glucose effect of glucocorticoids, so there is no significant increase in perioperative blood glucose levels in patients using glucocorticoids [24]. A low concentration of ropivacaine has a blocking effect on sensory-motor separation, and patients can get off the ground earlier, which can effectively cooperate with rehabilitation training.…”

Section: Discussionmentioning

confidence: 99%

Pain Management of Hallux Valgus Surgery Is Achieved by Cocktail Therapy

Xie

Zhu

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Background. Hallux valgus is a relatively common forefoot disease in clinical practice. The aim of our study was to assess the role of local cocktail drugs and postoperative pain after hallux valgus surgery. Methods. A retrospective case-control study was conducted to analyze 75 moderate to severe hallux valgus patients from June 1, 2018 to December 1, 2019. All patients were divided into cocktail and control groups according to whether the cocktail therapy was used or not after the operation. The anesthesiologist did not provide analgesic treatment other than nerve block anesthesia and intravenous anesthesia, such as analgesic pumps. The operative region of the cocktail group received a mixture of 10 ml of 0.75% ropivacaine, 10 ml of flurbiprofen axetil injection, and 1 ml of compound betamethasone injection, whereas the control group received nothing in the surgical spot. We recorded patients’ VAS scores preoperatively and at 6, 24 hours postoperatively; the length of hospital stay and the number of hospitalization expenses; the scores of Kolcaba comfort level; and the scores of Pittsburgh sleep quality. Result. There was no significant difference in age or sex between the two groups. The VAS scores at 6 and 24 hours postoperatively were significantly lower in the cocktail group. The average length of hospital stay was 8.24 days in the control group and 3.73 days in the cocktail group. The average total hospitalization cost of the control group was ¥28285.16, and that of the cocktail group was ¥22366.31. In expenses of total hospitalization costs, the cocktail group was lower than the control group. Kolcaba’s comfort various scores and the total score of the cocktail group were higher than the control group. The total score of PSQI and all dimensions in the experimental group were lower than those in the control group. Conclusion. We found a significant difference in the results of postoperative pain management except for age, sex, and hospitalization expenses. After hallux valgus surgery, inject cocktail drugs around the first metatarsophalangeal joint did reduce postoperative pain level. Level of Evidence. Level III, case-control study.

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