Interrelationship between splanchnic and leg exchange of glucose and other blood‐borne energy metabolites during abdominal surgical trauma
ABSTRACT In eight patients undergoing cholecystectomy, measurements of leg blood flow, splanchnic blood flow and arterio-venous differences in oxygen, glucose, lactate, pyruvate, glycerol, 3-hydroxybutyrate and alanine were made. Splanchnic glucose release averaged 1 1 mmol/min. The uptake of glucose into leg tissue was low. The rise in arterial glucose concentration was about I mmol/h during surgery. At the end of surgery splanchnic oxygen uptake was increased by 70% and the alanine uptake into the same region was comparable to that described in patients with septic complications of surgery. The plasma insulin concentration was low compared with the arterial glucose level.The data suggest that during abdominal surgery (a) increase in arterial glucose concentration can be fully accounted for by slightly increased splanchnic glucose release and a low peripheral utilization; (b) release of gluconeogenic substrates from peripheral tissues is balanced by splanchnic uptake; (c) disturbed relation between glucose and insulin, enhanced gluconeogenesis, increased splanchnic oxygen uptake and fat-mobilizing lipolysis are in accordance with a raised sympatho-adrenergic activity.
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ABSTRACT: Abdominal surgery increases blood glucose concentration and peripheral release and splanchnic uptake of gluconeogenic substrates, including alanine. During trauma or sepsis, infusion of glucose fails to depress alanine conversion to glucose. The effect of intra-operative glucose infusion on splanchnic metabolism was examined in the present study. In eight patients undergoing elective cholecystectomy, splanchnic glucose metabolism was investigated before, during and immediately after surgery. Glucose was infused at a constant rate of 1 mmol/min. Splanchnic blood flow and arterio-hepatic venous differences of oxygen, glucose, lactate, glycerol, 3-hydroxybutyrate and alanine were measured. Eight other patients, who received saline instead of glucose, served as a control group.Infusion of glucose resulted in total inhibition of splanchnic glucose release before as well as during and immediately after surgery. This was observed, even before surgery, at an arterial glucose level which was lower than that in the control group at the end of and immediately after surgery, at which no decrease of the splanchnic glucose release was recorded. Changes in neuronal and hormonal factors due to the surgical trauma are considered responsible for this difference in glucose homeostasis. Splanchnic alanine uptake increased during surgery in both groups, but tended to be somewhat lower in the glucose group. The arterial glycerol concentration and splanchnic uptake, as well as the arterial concentration and splanchnic release of 3-hydroxybutyrate, were reduced. It is concluded that an intravenous infusion of glucose at a rate of 1 mmol/min during abdominal surgery (a) increases the arterial blood glucose level and abolishes splanchnic glucose release, (b) reduces, but does not totally prevent the increase in splanchnic uptake of gluconeogenic substrates, and (c) diminishes lipolysis and the formation of 3-hydroxybutyrate.Clinical Physiology 06/2008; 1(5):511 - 523.
- Acta Anaesthesiologica Scandinavica 12/2008; 29(s82):1 - 8. · 2.36 Impact Factor
Article: Intraoperative fluid therapy[Show abstract] [Hide abstract]
ABSTRACT: The principles for intravenous administration of water, carbohydrates, and electrolytes during operations in adults, who were considered to be in balance prior to surgery, are detailed. The problem of blood replacement is likewise surveyed, with a view to coordinating these 2 clinical areas. A practical fluid therapy program is presented.Se detallan los principios para la administracin intravenosa de agua, carbohidratos y electrolitos durante operaciones realizadas en adultos considerados como en equilibrio antes de la ciruga. As mismo, se revisa el problema del reemplazo de sangre con el propsito de coordinar estas 2 reas clnicas. Se presenta un programa prctico de terapia de lquidos.Les principes qui rglent l'injection intraveineuse d'eau, d'hydrates de carbone et d'lectrolytes chez les adultes (en tat d'quilibre normal) au cours des interventions sont dcrits. Le problme de la compensation sanguine est galement pris en considration. La coordination entre ces deux lments de la ranimation est envisage et un protocole de traitement est prsent.World Journal of Surgery 01/1983; 7(5):581-589. · 2.23 Impact Factor