The hyperglycaemic response to surgery: pathophysiology, clinical implications and modification by the anaesthetic technique

A Randomized Controlled Trial of the Anticatabolic Effect of Epidural Analgesia and Hypocaloric Glucose

“…7,8 The inhibition of the hyperglycemic response to abdominal surgery by epidural analgesia has also long been recognized. 3 In the present protocol independent of the anesthetic technique, circulating glucose concentrations increased 2 days after surgery, lending support to the conclusion that the suppressive effect of epidural analgesia on glucose metabolism is limited to the intraoperative and immediate postoperative period. We assessed glucose production rates in our study because of a biochemical link between perioperative glucose and protein metabolism.…”

“…1,2 Furthermore, effective segmental pain relief by epidural anesthesia has been shown to attenuate hyperglycemia and to maintain protein homeostasis in patients undergoing major abdominal surgery. [3][4][5] We recently demonstrated that intraoperative epidural anesthesia followed by continuous epidural analgesia in contrast to general anesthesia alone combined with postoperative intravenous analgesia by use of morphine prevents the loss of whole-body protein on the second day after colorectal surgery. 6 In this study, all patients received glucose infusions from 24 hours before until 2 days after the operation.…”

Perioperative Glucose Control and Infection Risk in Older Surgical Patients

“…Patients with reduced glucose tolerance can be “pushed over” into hyperglycemia by this increase. This phenomenon can occur irrespective of a preexisting history of diabetes [13–15]. In addition, the physiologic stress response to surgery (or the acute condition leading up to surgery) results in alteration of endogenous hormone production, including increased serum cortisol production, insulin resistance, release of proinflammatory cytokines, and nervous system signals on metabolic pathways.…”

Pharmacological and Nonpharmacological Treatment After Cardiac Surgery

“…74,75 Similarly, patients with previous history of diabetes mellitus have a worse glycemic control issue in the perioperative phase. 74,75 Similarly, patients with previous history of diabetes mellitus have a worse glycemic control issue in the perioperative phase.…”