Interrelationship between splanchnic and leg exchange of glucose and other blood‐borne energy metabolites during abdominal surgical trauma

Department of Clinical Physiology, Linkoping University, S-581 85 Linkoping, Sweden
Clinical Physiology 06/2008; 1(1):59 - 72. DOI: 10.1111/j.1475-097X.1981.tb00874.x

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: The splanchnic exchange of amino acids was studied during and immediately after elective cholecystectomy in 10 patients given a constant infusion of glucose (1.1 mmol/min). Measurements of splanchnic blood flow and arteriohepatic venous differences of plasma amino acids, glucose, lactate and glycerol were made preoperatively, intraoperatively and twice in the immediate postoperative period. The arterial plasma concentration of most amino acids declined during and after surgery but the arterial concentration of alanine was highest in the postoperative period. The total splanchnic uptake of amino acids increased from 140.3 +/- 36.0 mumol/min preoperatively to 338.2 +/- 51.7 mumol/min postoperatively (p less than 0.05). Alanine and glutamine accounted for 65-70% of the total splanchnic uptake of amino acids throughout the investigation. The fractional extraction of methionine increased in the immediate postoperative period, while the fractional extraction of the remaining amino acids was stable. The splanchnic uptake of gluconeogenic substrates exceeded the splanchnic glucose release. The splanchnic uptake of amino acids had already increased intraoperatively and further increased postoperatively despite a net splanchnic glucose uptake in this period.
    Acta chirurgica Scandinavica 04/1986; 152:191-7.
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    ABSTRACT: Associated with surgical trauma is an increased release of gluconeogenic substrates from the periphery. The present study was undertaken to investigate the peripheral exchange of blood and plasma amino acids as well as some other gluconeogenic substrates (lactate and glycerol) in connection with abdominal surgery. Measurements of leg blood flow and femoral arterio-venous substrate differences were made before, during and immediately after elective cholecystectomy. Blood and plasma concentrations of most amino acids except alanine decreased during and immediately after surgery. Simultaneously there was an increased release of several of the amino acids as well as lactate and glycerol from the leg. The total release of plasma amino acids from one leg in the immediate postoperative period was about 2.5 times as high as before surgery. The turnover rates of amino acids as well as the changes in turnover rates were comparable whether the calculations were made from plasma or whole blood concentrations. At the end of surgery there was a high peripheral uptake of 3-hydroxybutyrate concomitant with a low release of amino acids.
    Clinical Nutrition 06/1986; 5(2):123-31. DOI:10.1016/0261-5614(86)90020-8 · 3.94 Impact Factor
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    ABSTRACT: The exchange of plasma amino acids and glucose, lactate, glycerol and 3-hydroxybutyrate in the leg was studied in otherwise healthy patients undergoing elective cholecystectomy. Seven patients were given a constant intravenous infusion of glucose at a rate of 1.1 mmol/min throughout the study. Seven other patients who received normal saline only served as a control group. Measurement of leg blood flow and arterio-femoral venous differences of amino acids and other energy metabolites were made on four occasions: (I) before surgery, (II) 10 min after skin incision, (III) at the end of surgery, and (IV) 30 min after the end of anaesthesia. The release of amino acids from the leg was comparable in the two groups before and during the early part of surgery. At the end of surgery the release of several individual amino acids, as well as the total release of amino acids, from the leg was higher in the patients given glucose infusion compared with the control patients. The infusion of glucose prevented the intraoperative rise in arterial levels and uptake of 3-hydroxybutyrate in the leg. A high release of amino acids at the end of surgery was thus associated with low arterial levels of 3-hydroxybutyrate while the reverse pattern was seen in the control patients. These effects of glucose infusion were qualitatively different from those seen in uninjured postabsorptive man.
    Clinical Science 12/1986; 71(5):487-96. · 5.63 Impact Factor