TITLE:
The Lower Infusion Rate of Glucose to Maintain Ketogenesis within Normal Level during Surgery
AUTHORS:
Jun Hirokawa, Sayuri Kadowaki, Masanori Tsukamoto, Takashi Hitosugi, Takeshi Yokoyama
KEYWORDS:
Glucose Administration, Insulin Resistance, Metabolism, Ketogenesis, General Anesthesia
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.7 No.8,
August
29,
2017
ABSTRACT: Background: Intraoperative low-dose glucose infusions suppress ketogenesis and attenuate postoperative insulin resistance (IR). However, the appropriate rate for intraoperative glucose infusion remains unclear, although a postoperative infusion of 0.08 g/kg/h effectively suppressed ketogenesis at the next morning. Therefore, we investigated the effects of an intraoperative rate of 0.08 g/kg/h on ketogenesis and postoperative IR. Methods: The present study included 15 patients who were undergoing maxillofacial surgery. The patients received glucose-free Ringer’s solution and a continuous glucose infusion (0.08 g/kg/h) during the surgery. Blood samples were collected to evaluate the concentrations of noradrenaline, cortisol, glucose, insulin, ketone bodies, and free fatty acid before anesthesia induction (T1), at 1 h after induction (T2), at 3 h after induction (T3), and at the end of surgery (T4). The glucose clamp test was performed on the days before and after surgery using the STG-55TM device. IR was quantified using the mean glucose infusion rate (M-value). Results: All 15 patients exhibited intraoperative blood glucose concentrations of 90 - 130 mg/dL. There was a non-significant trend towards higher plasma concentrations of total ketone bodies at T3 (p = 0.058). The plasma concentrations of acetoacetic acid at T3 and T4 were significantly higher than that at T1 (p = 0.0217 and p = 0.0306, respectively). All patients exhibited lower M-values after surgery (mean reduction: 48.0% ± 17.9%). Conclusion: Continuous intraoperative glucose at 0.08 g/kg/h helped maintain blood glucose concentrations, although it may suppress the ketogenesis to increase during surgery.