What is the optimal dose of glucose administration during minor surgery under sevoflurane anesthesia?

Terajima, Katsuyuki; Ogawa, Ryo

doi:10.1007/s005400050003

Cited by 3 publications

(4 citation statements)

References 14 publications

(14 reference statements)

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“…To assess the effects of glucose infusion on insulin resistance after surgery, further study is needed. During surgery, it has been reported that infusion of 0.1 g glucose/kg BW/h has positive effects, including preventing glycogen depletion 30 and preventing lipolysis and ketosis, 40 and these effects are not dose-dependent. Con-sidering all of these findings, a low-rate glucose infusion of 0.1 g • kg -1 • h -1 appears to have clinical potential to suppress muscle protein breakdown.…”

Section: Discussionmentioning

confidence: 99%

Glucose Infusion Suppresses Surgery-induced Muscle Protein Breakdown by Inhibiting Ubiquitin-proteasome Pathway in Rats

Mikura

Yamaoka²,

Doi³

et al. 2009

Anesthesiology

129

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Section: Discussionmentioning

confidence: 99%

Glucose Infusion Suppresses Surgery-induced Muscle Protein Breakdown by Inhibiting Ubiquitin-proteasome Pathway in Rats

Mikura

Yamaoka²,

Doi³

et al. 2009

Anesthesiology

129

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“…Lastly, we noticed that in the intervention group, providers co-administered dextrose (5 % at 100 ml/ Hr) with insulin in significantly more number of cases when compared with the baseline (68.4 % for intervention when compared with 54 % for baseline). Co-administration of dextrose with insulin is recommended by the UW protocol to minimize catabolic effect in fasting surgical patients [40]. In compliance with this recommendation SAM prompts providers to co-administer dextrose with insulin (Rule GLU5 in Table 1).…”

Section: Discussionmentioning

confidence: 95%

Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol

Nair

Grunzweig

Peterson

et al. 2015

J Clin Monit Comput

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Poor perioperative glycemic management can lead to negative surgical outcome. Improved compliance to glucose control protocol could lead to better glucose management. An Anesthesia Information Management System based decision support system-Smart Anesthesia Manager™ (SAM) was used to generate real-time reminders to the anesthesia providers to closely adhere to our institutional glucose management protocol. Compliance to hourly glucose measurements and correct insulin dose adjustments was compared for the baseline period (12 months) without SAM and the intervention period (12 months) with SAM decision support. Additionally, glucose management parameters were compared for the baseline and intervention periods. A total of 1587 cases during baseline and 1997 cases during intervention met the criteria for glucose management (diabetic patients or non-diabetic patients with glucose level >140 mg/dL). Among the intervention cases anesthesia providers chose to use SAM reminders 48.7 % of the time primarily for patients who had diabetes, higher HbA1C or body mass index, while disabling the system for the remaining cases. Compliance to hourly glucose measurement and correct insulin doses increased significantly during the intervention period when compared with the baseline (from 52.6 to 71.2 % and from 13.5 to 24.4 %, respectively). In spite of improved compliance to institutional protocol, the mean glucose levels and other glycemic management parameters did not show significant improvement with SAM reminders. Real-time electronic reminders improved intraoperative compliance to institutional glucose management protocol though glycemic parameters did not improve even when there was greater compliance to the protocol.

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“…Unlike anesthesia with propofol and an opioid analgesic (sufentanil, fentanyl), anesthesia with a volatile gas (enflurane, isoflurane, sevoflurane) cannot sufficiently block the invasiveness of surgery, which leads to elevated plasma cortisol levels and a failure to sufficiently suppress the endocrine stress response [26–29]. Administering glucose to a patient under these conditions suppresses lipid and protein catabolism, but tends to cause exaggerated hyperglycemia [3,4,15,16]. Anesthesia with fentanyl or remifentanil, on the other hand, suppresses the stress response and reduces ACTH and cortisol levels regardless of the extent of surgery, and, thus, inhibits lipid mobilization without triggering hyperglycemia following low-dose glucose administration [17,19].…”

Section: Discussionmentioning

confidence: 99%

“…The stress response of the endocrine and metabolic systems to the insult of surgery lowers insulin secretion, which in turn lowers insulin sensitivity, increases the release of catabolic hormones, reduces glucose utilization, and increases gluconeogenesis, thus increasing blood glucose levels [13–16]. Many studies have found that administration of low-dose glucose solutions during surgery, on the other hand, suppresses the level of blood ketone bodies and free fatty acids (FFAs) without substantially increasing blood glucose levels, and also increases insulin levels [3,4,13,14,17].…”

Section: Introductionmentioning

confidence: 99%

Effects of preoperative oral carbohydrate intake on catabolism, nutrition and adipocytokines during minor surgery: A randomized, prospective, controlled clinical phase II trial

et al. 2019

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Background We investigated the effects of preoperative oral carbohydrate loading on intraoperative catabolism, nutritional parameters, and adipocytokine levels during anesthesia. Methods Study participants were randomized to two groups who were allowed to consume either no more than 250 mL of 18% oral carbohydrate solution (Arginaid Water: AW group) or no more than 500 mL of plain water (PW group) within the 2 hours before surgery, with no intraoperative glucose administration. Percentage changes from preoperative values of resting metabolic rate (RMR) and total body water (TBW), determined by bioelectrical impedance analysis (BIA), were compared. Blood levels of serum ketone bodies, free fatty acids (FFAs), insulin, 3-methyl histidine, blood glucose, retinol binding protein, adiponectin, and leptin were measured. BIA measurement and blood sampling were performed on entry to the operating room (M1) and 2 hours after the induction of anesthesia (M2). Chi squared test, Mann-Whitney U test, and Wilcoxon’s test were used for comparisons of parameters. P values less than 0.05 constituted a significant difference. Results Seventeen patients per group (34 patients total) were enrolled. RMR and TBW values did not differ between M1 and M2 measurements. Participants in the AW group had lower blood ketone body and FFA levels and higher insulin levels at M1. However, their ketone body and FFA levels rose and insulin levels fell after 2 hours, although ketone body and FFA levels in the AW group were still lower than those in the PW group. Although retinol binding protein, adiponectin, and leptin levels were not different in terms of preoperative oral carbohydrate loading, the levels of these substances in both groups were lower after 2 hours compared with levels on operating room entry. Conclusions Preoperative oral carbohydrate loading without intraoperative glucose administration appears to suppress catabolism for 2 hours after the start of surgery.

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What is the optimal dose of glucose administration during minor surgery under sevoflurane anesthesia?

Abstract: The smaller doses of glucose (0.1-0.2 g.kg(-1).h(-1)) prevented lipolysis and hyperglycemia during minor surgery.

Cited by 3 publications

References 14 publications

Glucose Infusion Suppresses Surgery-induced Muscle Protein Breakdown by Inhibiting Ubiquitin-proteasome Pathway in Rats

Glucose Infusion Suppresses Surgery-induced Muscle Protein Breakdown by Inhibiting Ubiquitin-proteasome Pathway in Rats

Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol

Effects of preoperative oral carbohydrate intake on catabolism, nutrition and adipocytokines during minor surgery: A randomized, prospective, controlled clinical phase II trial

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