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, SwedenClinical Physiology 06/2008; 1(1):59 - 72. DOI: 10.1111/j.1475-097X.1981.tb00874.x
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: Thirteen patients with gallbladder disease but otherwise healthy were studied in connection with cholecystectomy. Specimens of the lateral vastus muscle were taken by the percutaneous needle biopsy technique during anaesthesia before surgery, on two occasions during surgery and 30 min after discontinuation of anaesthesia. The muscle samples were analysed for glycogen, lactate, citrate, ATP, phosphoryl creatine, creatine and water content. Citrate and lactate concentrations in muscle increased continuously throughout the study. There were no significant changes in the concentration of glycogen, phosphoryl creatine, and ATP in muscle tissue. The increase in citrate concentration is probably related to an augmented uptake and combustion of free fatty acids and 3-hydroxybutyrate in this situation. The data suggest that during anaesthesia and abdominal surgery an increase in the muscle citrate concentration may contribute to the modulation of carbohydrate utilization in skeletal muscle.Clinical Physiology 07/1981; 1(3):305-12. DOI:10.1111/j.1475-097X.1981.tb00899.x
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ABSTRACT: Like other investigators, we have found that the postoperative period is characterized by high energy expenditure, pain, high plasma catecholamines and decreased arterial oxygen tension, and also glycogenolysis, lipolysis, proteolysis and a low turn-over rate of glucose. Regional anaesthesia has often been supposed to counteract some of these phenomena without causing ventilatory depression. During the past few years a number of studies have been carried out in our department with the aim of elucidating possible differences between the effects of systemic analgesics and different regional anaesthetic blockades. Thus, we have found that both systemic analgesics and regional anaesthesia decrease the total postoperative energy expenditure. Adequately administered regional anaesthesia and systemic analgesic therapy both relieve postoperative pain, the former without interfering with normal ventilatory function. In addition, regional anaesthetic techniques cause less mental confusion, fewer bowel problems and possibly less postoperative lung complications. Moreover, high spinal blockades seem to be the only means of reducing the post-traumatic metabolic stress reaction.Acta anaesthesiologica Scandinavica. Supplementum 02/1982; 74(s74):169-72. DOI:10.1111/j.1399-6576.1982.tb01871.x
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. DOI:10.1007/BF01655333 · 2.64 Impact Factor
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