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The influence of glucose load on metabolism during minor surgery using remifentanil‐induced anesthesia
Author(s) -
KAMBE N.,
TANAKA K.,
KAKUTA N.,
KAWANISHI R.,
TSUTSUMI Y. M.
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12335
Subject(s) - medicine , ketogenesis , remifentanil , ketone bodies , anesthesia , carbohydrate metabolism , endocrinology , perioperative , insulin , lipid metabolism , anesthetic , surgical stress , metabolism , propofol
Background During perioperative fasting, lipid metabolism gradually increases, resulting in free fatty acids ( FFA ) and/or ketone bodies. Suppression of surgical stress by remifentanil may allow the safe administration of glucose infusions, avoiding both hyperglycemia and ketogenesis. The effects of glucose infusion on glucose and lipid metabolism were therefore investigated in patients undergoing minor surgery with remifentanil anesthesia. Methods Thirty‐four patients were randomized 1 : 1 to receive no glucose (0G group) or low‐dose glucose (0.1 g/kg/h for 1 h followed by 0.05 g/kg/h for 1 h; LG group). The concentrations of glucose, adrenocorticotropic hormone ( ACTH ), 3‐methylhistidine (3‐ MH ), insulin, cortisol, FFA , creatinine ( Cr ), and ketone bodies were measured before anesthetic induction, 1 and 2 h after glucose infusion, at the end of surgery, and the next morning. Results The concentrations of cortisol and ACTH decreased during surgery in both groups when compared with the concentrations before anesthesia and at the end of surgery ( P < 0.05). Glucose and insulin concentrations were significantly higher in the LG than in the 0 G group at 1 and 2 h after infusion. No patient experienced hyperglycemia. The concentrations of FFA and ketone bodies were lower in the LG than in the 0 G group during surgery, but there were no significant between group differences in 3‐ MH/Cr . Conclusion Infusion of low‐dose glucose attenuated fat catabolism without causing hyperglycemia, indicating that infusion of low‐dose glucose during remifentanil‐induced anesthesia may be safe for patients.