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| 2. |
- Nygren, Jonas, et al.
(författare)
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Preoperative oral carbohydrate administration reduces postoperative insulin resistance
- 1998
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Ingår i: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 17:2, s. 65-71
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Tidskriftsartikel (refereegranskat)abstract
- Infusions of carbohydrates before surgery reduce postoperative insulin resistance. We investigated the effects of a carbohydrate drink, given shortly before surgery, on postoperative metabolism. Method: Insulin sensitivity, glucose turnover ([6,6, 2H2]-D-glucose) and substrate utilization were measured using hyperinsulinemic normoglycemic clamps and indirect calorimetry in two matched groups of patients before and after elective colorectal surgery. The drink group (n = 7) received 800 ml of an isoosmolar carbohydrate rich beverage the evening before the operation (100 g carbohydrates), as well as another 400 ml (50 g carbohydrates) 2 h before the initiation of anesthesia. The fasted group (n = 7) was operated after an overnight fast. Results: After surgery, energy expenditure increased in both groups. Endogenous glucose production was higher after surgery and the difference was significant during low insulin infusion rates in both groups (P < 0.05). The supressibility of endogenous glucose production by the two step insulin infusion was similar pre- and postoperatively in both groups. At the high insulin infusion rate postoperatively, whole body glucose disposal was more reduced in the fasted group (-49 ± 6% vs -26 ± 8%, P < 0.05 vs drink). Furthermore, during high insulin infusion rates, glucose oxidation decreased postoperatively only in the fasted group (P < 0.05) and postoperative levels of fat oxidation were greater in the fasted group (P < 0.05 vs drink). Only minor postoperative changes in cortisol and glucagon were found and no differences were found between the treatment groups. Conclusions: Patients given a carbohydrate drink shortly before elective colorectal surgery displayed less reduced insulin sensitivity after surgery as compared to patients who were operated after an overnight fast.
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| 3. |
- Alibegovic, A., et al.
(författare)
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The effect of alpha 2 receptor agonists on central haemodynamic and blood glucose during hemorrhagic stress in the rat
- 1998
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Ingår i: Surgical Research Communications. - : Harwood Academic. - 0882-9233. ; 9:2-4, s. 151-164
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Tidskriftsartikel (refereegranskat)abstract
- The effect of the selective alpha 2 agonist Mivazerol on catecholamine levels in plasma, and on central hemodynamics and blood glucose levels developments during hemorrhagic stress in rats was investigated. The animals were randomly given either saline, low dose of Mivazerol (0.6 μg/ml) or high dose (2.0 μg/ml) at a rate of 30 μl/100 g/min, beginning the infusions intravenously 30 min before onset and throughout 60 min of hemorrhagic stress. Before hemorrhage, Mivazerol raised mean arterial pressure, and reduced heart rate, adrenaline and noradrenaline levels in a dose dependent fashion. High dose infusion also resulted in an elevation in blood glucose. During hemorrhage, the high dose effectively dampened the catecholamine response. Simultaneously, the same group maintained better mean arterial pressure in response to hemorrhage. Blood glucose levels were elevated to similar levels regardless of treatment. These data indicate that Mivazerol effectively reduced the catecholamine response to severe hemorrhagic stress, while central hemodynamic and blood glucose responses were maintained or improved.
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| 4. |
- Bang, P., et al.
(författare)
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Postoperative induction of insulin-like growth factor binding protein-3 proteolytic activity : relation to insulin and insulin sensitivity
- 1998
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - Cary, NC, USA : Oxford University Press. - 0021-972X .- 1945-7197. ; 83:7, s. 2509-2515
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Tidskriftsartikel (refereegranskat)abstract
- Increased serum insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3) proteolytic activity (IGFBP-3-PA) has been demonstrated in a number of clinical states of insulin resistance, including severe illness, after surgery, and in noninsulin-dependent diabetes mellitus. In the present study we assessed the role of insulin sensitivity in expression of IGFBP-3-PA in serum. In 18 patients studied, a significant increase in IGFBP-3-PA (P < 0.005) was demonstrated after cole-rectal surgery. Eight patients receiving an oral glucose load before surgery demonstrated a significant greater relative increase in IGFBP-3-PA compared with 10 patients not receiving glucose (32.9 +/- 7.1% vs. 8.6 +/- 6.7%, respectively; P < 0.05). Both groups had reduced insulin sensitivity after surgery(-58 +/- 4%; P < 0.0001; n = 18), as determined by hyperinsulinemic, normoglycemic clamps; however, the group not receiving glucose displayed 18% less insulin sensitivity than the oral glucose load group (P < 0.05). Multiple regression analysis demonstrated that the relative changes in IGFBP-3-PA and C peptide levels were inversely correlated (P < 0.05), suggesting that increased IGFBP-3-PA, presumably increasing IGF bioavailability, may be associated with decreased insulin demands. Interestingly, insulin infusion during the 4-h hyperinsulinemic, normoglycemic clamp performed 24 h after surgery (post-op) resulted in a further increase in IGFBP-3-PA in both groups (P < 0.005), whereas no significant responses could be demonstrated during the pre-op clamp. The expression of increased IGFBP-3-PA was accompanied by conversion of endogenous intact 39/42-kDa IGFBP-3 into its 30-kDa fragmented form as determined by Western immunoblotting, and this conversion was virtually complete after the 4-h post-op clamp in patients displaying marked increases in IGFBP-3-PA. Characterization of the IGFBP-3-PA demonstrated that it was specific for IGFBP-3, as no degradation of IGFBP-1 and -2 was detected, and the use of various protease inhibitors demonstrated that serine proteases and possibly matrix metalloproteinases contribute to the increased IGFBP-3-PA level after surgery. We propose that IGF bioavailability may be increased by the induction of IGFBP-3-PA in insulin-resistant subjects, and that insulin regulates IGFBP-3-PA in this state.
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| 5. |
- Gannedahl, Per E., et al.
(författare)
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Vectorcardiographic changes as predictors of cardiac complications during major vascular surgery
- 1998
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Springer. - 1053-0770 .- 1532-8422. ; 12:1, s. 38-44
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To elucidate the relation of changes in computerized vectorcardiographictrend parameters indicating perioperative myocardial ischemia with perioperative cardiaccomplications.DESIGN:Prospective clinical study.SETTING:A single university hospital.PARTICIPANTS:Thirty-eight patients undergoing elective abdominal aortic surgery.INTERVENTIONS:Computerized vectorcardiography recorded during surgery and for 48 hours postoperatively.MEASUREMENTS AND MAIN RESULTS:Vectorcardiographic spatial alterations in the QRS complex (QRS-VD) and absolute (ST-VM) and spatial (STC-VM) ST-segment changes, previously used indicators of myocardial ischemia, were analyzed and related to the cardiac events detected clinically. In five patients with clearly ischemic (cardiac death, myocardial infarction, recurrent ischemia) and eight patients with possibly ischemic (congestive heart failure, arrhythmia) perioperative cardiac events, ST-VM and STC-VM were significantly increased intraoperatively. Postoperatively, these differences remained, but QRS-VD were also significantly increased. Intraoperative and postoperative changesindicating ischemia were strongly related (r = 0.83). The signs of ischemia were most pronounced during the postoperative 12 to 36 hours. The presence of 60 minutes of signs of ischemia during 2 hours revealed high sensitivity (85%), specificity (80%), and positive (69%) and negative (91%) predictive values for subsequent cardiac events. Traditional vector loop analysis showed signs of non-Q-wave infarctions in six patients, whereas only three of these were detected using standard clinical methods.CONCLUSIONS:Vectorcardiographic signs of myocardial ischemia were significantly increased intraoperatively, but most pronounced postoperatively in the patients subsequently suffering cardiac events. The changes could be related to the individual cardiac morbidity with acceptable precision. Thus, continuous vectorcardiographicmonitoring may be beneficial for patients at risk of developing perioperative ischemia.
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| 6. |
- Ljungqvist, Olle, 1954-, et al.
(författare)
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Modulating the insulin response to hemorrhage in the fasted rat with pre-stress glucose infusion
- 1998
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Ingår i: Surgical communication Research. - : Harwood Academic. - 0882-9233. ; 9:2-4, s. 85-96
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Tidskriftsartikel (refereegranskat)abstract
- Elective surgery is usually performed after an overnight fast. Recent data suggests that pre-operative glucose loading instead of fasting is beneficial for postoperative metabolism by reducing insulin resistance. In this experimental study in rats, we examined the effects of pre-stress glucose infusion on the endocrine response to hemorrhage. Twenty-four hour food deprived rats received a 3 h continuous infusion of 30% glucose (0.3 mg/100 g b.wt./h) or the same volume of normal saline prior to standardized 35% blood loss during 60 min. Infusion of glucose resulted in a six fold increase in liver glycogen, and a twofold higher increment of blood glucose during hemorrhage, compared to saline treated rats. Animals given glucose developed a twofold increase in insulin during hemorrhage, which was not present in saline treated rats. Glucagon, catecholamines and corticosterone levels were elevated in a similar fashion in both groups during hemorrhage. These results indicate that the release of insulin in response to stress can be modulated by pre-treatment with glucose.
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| 7. |
- Odeberg, S., et al.
(författare)
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Lack of neurohumoral response to pneumoperitoneum for laparoscopic cholecystectomy
- 1998
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Ingår i: Surgical Endoscopy. - : Springer-Verlag New York. - 0930-2794 .- 1432-2218. ; 12:10, s. 1217-1223
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pneumoperitoneum (PP) for laparoscopic surgery induces prompt changes in circulatory parameters. The rapid onset of these changes suggests a reflex origin, and the present study was undertaken to evaluate whether release of vasopressor substances could be responsible for these alterations. The influence of two different anesthesia techniques was also evaluated. Methods: American Society of Anesthesiologists (ASA) class I patients, scheduled for laparoscopic cholecystectomy, were investigated. The first group (n = 10) was anesthetized intravenously. The second group (n = 6) had inhalation anesthesia. Plasma vasopressin, catecholamines, and plasma renin activity were investigated as neurohumoral vasopressor markers of circulatory stress. The general stress response to surgery was assessed by analysis of plasma cortisol. Results: Induction of pneumoperitoneum caused no apparent activation of vasopressor substances, although several hemodynamic parameters responded promptly. Conclusion: The hemodynamic alterations, seen at the establishment of PP during stable anesthesia, cannot be explained by elevation of vasopressor substances in circulating blood.
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| 8. |
- Odeberg, S., et al.
(författare)
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Pneumoperitoneum for laparoscopic cholecystectomy is not associated with comprised splanchnic circulation
- 1998
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Ingår i: European Journal of Surgery. - : Taylor & Francis Scandinavia. - 1102-4151 .- 1741-9271. ; 164:11, s. 843-848
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the influence of increased intra-abdominal pressure during pneumoperitoneum on splanchnic circulation.Design: Open study.Setting: University hospital, Sweden.Subjects: Five otherwise healthy patients (mean age of 34 years), undergoing laparoscopic cholecystectomy.Interventions: Arterial and hepatic vein catheterization and simultaneous arterial and hepatic vein blood gas sampling in the awake state, during anaesthesia, after the establishment of pneumoperitoneum (intra-abdominal pressure level 11-13 mmHg) and after 30 and 60 minutes of pneumoperitoneum.Main outcome measures: Hepatic blood flow was estimated by the continuous infusion method and used as a measure of splanchnic blood flow. Splanchnic oxygen consumption was calculated according to the Fick principle.Results and conclusion: Splanchnic blood flow and splanchnic oxygen consumption were not affected by pneumoperitoneum at this level of intra-abdominal pressure.
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