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: 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. · 4.86 Impact Factor
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ABSTRACT: Oxygen transport to and substrate turnover in leg muscle were studied at rest and during light and heavy upright bicycle exercise in two brothers with a hereditary hemoglobinopathy associated with high oxygen affinity (P50 = 13 mmHg). Femoral venous oxygen tension was below normal and femoral venous oxygen saturation above normal at rest and during exercise. Thus, the arterial-femoral venous oxygen saturation difference was decreased. Despite a compensatory increase in hemoglobin concentration, the arterial-femoral venous oxygen content difference tended to be below normal at heavy exercise. Approximately 25% of the oxygen was delivered via the abnormal hemoglobin at relative heavy exercise. Arterial lactate levels, lactate release, and muscle lactate concentration were not increased at any level of exercise. Glucose, alanine, pyruvate, and glycerol turnover were essentially normal, but the glycogen and creatine phosphate stores were abnormally depleted at the termination of heavy exercise. The exercise electrocardiogram (ECG) was normal, indicating that myocardial oxygenation was adequate. Muscle-surface oxygen pressure fields were normal at rest (not investigated during exercise). It is concluded that the high oxygen affinity of the hemoglobin in our two subjects did not lead to heart or skeletal muscle hypoxia during heavy exercise, as judged from the ECG and from the leg lactate turnover. Despite the lack of evidence for muscle hypoxia, the subjects experienced leg muscle fatigue and the creatine phosphate and glycogen stores were depleted more than normally.Journal of Clinical Investigation 11/1983; 72(4):1376-84. · 12.81 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