| 1. |
- Ljungqvist, Olle, 1954-, et al.
(författare)
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Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance
- 1994
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Ingår i: Journal of the American College of Surgeons. - 1072-7515 .- 1879-1190. ; , s. 329-336
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Tidskriftsartikel (refereegranskat)abstract
- In severe catabolic states, such as burn injury, sepsis and accidental injury, a state of marked insulin resistance is encountered. Insulin resistance is also present after elective surgical treatment, more pronounced with increasingly greater magnitude of operation performed. Results of recent animal experiments have shown that even short periods of food deprivation, reducing carbohydrate reserves, alter responses to stress. This notion resulted in our questioning the rationale of carbohydrate depletion associated with overnight preoperative fasting. Twelve patients undergoing elective open cholecystectomy were randomly given no infusion (control group) or 5 milligrams per kilogram per minute of glucose infusion (glucose group) during preoperative overnight fasting. Insulin sensitivity (M value, milligram per kilogram per minute) was determined using the hyperinsulinemic normoglycemic clamp (plasma insulin level, 65 microunits per milliliter and blood glucose level, 4.5 millimoles per liter) before and the first postoperative day. Preoperative insulin sensitivity was similar in the two groups. Postoperatively, M values decreased by 55±3 percent (control group) and by 32±5 percent (glucose group) (p<0.01). Plasma levels of insulin, c- peptide, glucagon, growth hormone, catecholamines and cortisol in connection with clamps were similar in both groups preoperatively and postoperatively. The present results indicate that active preoperative carbohydrate preservation may improve postoperative metabolism because postoperative occurrence of insulin resistance was reduced with preoperative glucose infusion.
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| 2. |
- Ahlman, B., et al.
(författare)
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Short-term starvation alters the free amino acid content of human intestinal mucosa
- 1994
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Ingår i: Clinical Science. - : Portland Press. - 0143-5221 .- 1470-8736. ; 86:6, s. 653-662
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Tidskriftsartikel (refereegranskat)abstract
- 1. The effects of short-term starvation and refeeding on the free amino acid concentrations of the intestinal mucosa were characterized in male subjects (n=6), using endoscopically obtained biopsy specimens from the duodenum and from all four segments of the colon.2. The alterations in the amino acid concentrations in response to short-term starvation were overall uniform in both duodenal and colonic mucosa as well as in plasma. Most amino acids decreased, whereas branched-chain amino acids increased.3. In the colon, glutamic acid and glutamine decreased during the starvation period, whereas they remained unaltered in the duodenum. This was the major difference in response to short-term starvation between the amino acid concentrations in the intestinal mucosa of the duodenum and colon.4. Refeeding for 3 days normalized the amino acid concentrations except for glutamic acid, asparagine and histidine, which remained low in the colon, and threonine, which showed an overshoot in both parts of the intestine. S. The changes in mucosal amino acid concentrations seen in response to starvation and refeeding were uniform in the four segments of the colon. This suggests that sampling from the rectum/sigmoid colon will give representative values for the free amino acid concentrations of the entire large intestine.
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| 3. |
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| 4. |
- Ljungqvist, Olle, 1954-, et al.
(författare)
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Hyperglycemia and survival after haemorrhage
- 1994
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Ingår i: European Journal of Surgery. - : Taylor & Francis. - 1102-4151 .- 1741-9271. ; 160:9, s. 465-469
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the relation between the degree of hyperglycaemia during a standard haemorrhage and survival.Design: Prospective laboratory studySetting: University department of surgery, Sweden.Material: 5 groups of 8-12 adult male Sprague-Dawley rats.Interventions: Different degrees of hyperglycaemia were achieved in the 5 groups of rats (which had been starved for 24 hours) by infusion of the same amount of 0.9% saline, or 5%, 10%, 20% or 30% glucose during a 48% standard haemorrhage over 60 minutes. Blood glucose concentration and packed cell volume were measured every 30 minutes, and mean arterial pressure was monitored constantly.Main Outcome Measure: Survival at 7 days.Results: Increases in blood glucose concentrations during haemorrhage correlated with plasma refill as indicated by reductions in packed cell volume (r = 0.85, p < 0.0001). Both increases in blood glucose concentrations and reductions in packed cell volume were inversely related to blood pressure during haemorrhage (p < 0.0001). The more glucose that was infused, the higher the blood glucose concentration and the better the plasma refill during haemorrhage which correlated with improvement in the rate of survival at 7 days (p < 0.001).Conclusion: The ability to mount a hyperglycaemic response is an important prognostic factor in survival after experimental haemorrhage.
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| 5. |
- Thorell, Anders, et al.
(författare)
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Insulin resistance after abdominal surgery
- 1994
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 81:1, s. 59-63
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Tidskriftsartikel (refereegranskat)abstract
- A study was carried out to determine the time course and degree of postoperative insulin resistance in patients undergoing elective abdominal surgery. Mean(s.e.m.) insulin sensitivity was determined before and on the first (n = 10), fifth, ninth and 20th (n = 5) days after elective open cholecystectomy using the normoglycaemic (4.(0.1) mmol/l), hyperinsulinaemic (402(12) pmol/l) glucose clamp technique. Preoperative insulin sensitivity expressed as the M value varied from 2.3 to 8.2 mg per kg per min. The relative reduction in insulin sensitivity was most pronounced on the first day after surgery, at a mean(s.e.m) of 54(2) per cent. Thereafter, a large variation between individuals was found during the course of recovery, and insulin sensitivity returned to normal 20 days after operation. On the first day after surgery, plasma concentrations of glucose, C peptide, noradrenaline and glucagon were slightly but significantly higher than before operation (P<0.05), whereas insulin, growth hormone, cortisol and adrenaline levels were unaltered. Marked insulin resistance thus develops after elective upper abdominal surgery and persists for at least 5 days after operation. Factors other than simultaneous changes in levels of the hormones studied seem to regulate the maintenance of postoperative insulin resistance
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| 6. |
- Giesecke, Kajsa, et al.
(författare)
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The modifying influence of anaesthesia on postoperative protein catabolism
- 1994
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 72:6, s. 697-699
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Tidskriftsartikel (refereegranskat)abstract
- We studied two groups of six patients scheduled for gastrointestinal surgery; they were allocated randomly to receive high- or low-dose fentanyl anaesthesia. The confounding effect of protein balance, before the trauma of surgery, on postoperative nitrogen excretion was controlled by standardized protein intake before operation, supplemented by adequate calories. The high-dose group had significantly lower stress levels during surgery, assessed by arterial blood concentrations of cortisone, adrenaline and glucose. After operation, protein catabolism was measured for 7 days. The high-dose group had significantly lower postoperative excretion of ammonia and slightly lower excretion of urea and 3-methylhistidine. Low-stress anaesthesia may thus diminish postoperative catabolism, which could be important in frail patients by reducing mortality, ICU resources, or both.
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| 7. |
- Odeberg, S., et al.
(författare)
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Hemodynamiceffects of pneumoperitoneum and the influence of posture during anaesthesia forlaparoscopic surgery
- 1994
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley-Blackwell Publishing Inc.. - 0001-5172 .- 1399-6576. ; 38:3, s. 276-283
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Tidskriftsartikel (refereegranskat)abstract
- The laparoscopic operating technique is being applied increasingly to a variety of intra‐abdominal operations. Intra–abdominal gas insufflation, i.e. pneumoperitoneum (PP), is then used to allow surgical access. The haemodynamic effects of PP in combination with different body positions have not been fully examined. Eleven patients without signs of cardiopulmonary disease were studied before and during laparoscopic cholecystectomy under propofol–fentanyl anaesthesia with controlled ventilation. Swan‐Ganz and radial arterial catheterization were used to determine haemodynamic data in the horizontal position, with a 15–20° head–down tilt and a 15–20° head–up tilt. The measurements were repeated after insufflation of carbon dioxide to an intraabdominal pressure of 11–13 mmHg, as well as during surgery. The ventricular filling pressures of the heart were strictly dependent on body position. PP in the horizontal position increased pulmonary capillary wedge pressure by 32% (P < 0.01), central venous pressure by 58% (P < 0.01), and mean arterial pressure by 39% (P < 0.01). When PP was combined with a head–down tilt, there was a further increase in filling pressures by approximately 40% (P < 0.01), while the reduction in filling pressures during the head–up tilt was counteracted by PP. During PP with a head–up tilt, the filling pressures did not differ from those in the horizontal position without PP. CI showed a certain dependency on filling pressures. It is concluded that PP causes signs of elevated preload and afterload. The combination of PP and a head–up tilt is associated only with signs of an elevated afterload. It is suggested that the haemodynamic response to PP, especially in combination with a head–down tilt, may be hazardous to patients with compromised heart function.
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