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The effect of gluco...
The effect of glucose control in liver surgery on glucose kinetics and insulin resistance
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- Blixt, Christina (författare)
- Dept. of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Dept of Anesthesia and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden,Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ, Dept Anesthesia & Intens Care, Hosp Huddinge, Stockholm, Sweden.;Karolinska Univ, Perioperat Med & Intens Care, Hosp Huddinge, Stockholm, Sweden.
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- Larsson, Mirjam (författare)
- Dept. of Anesthesia and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden,Karolinska Univ, Dept Anesthesia & Intens Care, Hosp Huddinge, Stockholm, Sweden.;Karolinska Univ, Hosp Solna, Perioperat Med & Intens Care, S-17176 Stockholm, Sweden.
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- Isaksson, Bengt (författare)
- Uppsala universitet,Gastrointestinalkirurgi
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- Ljungqvist, Olle, 1954- (författare)
- Örebro universitet,Institutionen för medicinska vetenskaper,Department of Surgery, Örebro University Hospital, Sweden,Örebro Univ, Dept Surg, Sch Med Sci, SE-70185 Örebro, Sweden.;Örebro Univ Hosp, Dept Surg, SE-70185 Örebro, Sweden.
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- Rooyackers, Olav (författare)
- Karolinska Institutet,Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.
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Dept of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Dept of Anesthesia and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ, Dept Anesthesia & Intens Care, Hosp Huddinge, Stockholm, Sweden.;Karolinska Univ, Perioperat Med & Intens Care, Hosp Huddinge, Stockholm, Sweden. (creator_code:org_t)
- Churchill Livingstone, 2021
- 2021
- Engelska.
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Ingår i: Clinical Nutrition. - : Churchill Livingstone. - 0261-5614 .- 1532-1983. ; 40:7, s. 4526-4534
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Abstract
Ämnesord
Stäng
- BACKGROUND & AIMS: Clinical outcome is negatively correlated to postoperative insulin resistance and hyperglycemia. The magnitude of insulin resistance can be modulated by glucose control, preoperative nutrition, adequate pain management and minimal invasive surgery. Effects of glucose control on perioperative glucose kinetics in liver surgery is less studied.METHODS: 18 patients scheduled for open hepatectomy were studied per protocol in this prospective, randomized study. In the treatment group (n = 9), insulin was administered intravenously to keep arterial blood glucose between 6 and 8 mmol/l during surgery. The control group (n = 9) received insulin if blood glucose >11.5 mmol/l. Insulin sensitivity was measured by an insulin clamp on the day before surgery and immediately postoperatively. Glucose kinetics were assessed during the clamp and surgery.RESULTS: Mean intraoperative glucose was 7.0 mM (SD 0.7) vs 9.1 mM (SD 1.9) in the insulin and control group respectively (p < 0.001; ANOVA). Insulin sensitivity decreased in both groups but significantly (p = 0.03, ANOVA) more in the control group (M value: 4.6 (4.4-6.8) to 2.1 (1.2-2.6) and 4.6 (4.1-5.0) to 0.6 (0.1-1.8) mg/kg/min in the treatment and control group respectively). Endogenous glucose production (EGP) increased and glucose disposal (WGD) decreased significantly between the pre- and post-operative clamps in both groups, with no significant difference between the groups. Intraoperative kinetics demonstrated that glucose control decreased EGP (p = 0.02) while WGD remained unchanged (p = 0.67).CONCLUSION: Glucose control reduces postoperative insulin resistance in liver surgery. EGP increases and WGD is diminished immediately postoperatively. Insulin seems to modulate both reactions, but mostly the WGD is affected. Intraoperative EGP decreased while WGD remained unaltered.REGISTRATION NUMBER OF CLINICAL TRIAL: ANZCTR 12614000278639.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
Nyckelord
- Glucose control
- Glucose kinetics
- Insulin resistance
- Postoperative
- Stress hyperglycemia
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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