Comparison of two anesthesia techniques on perioperative insulin response to i.v. glucose infusion in children.
Perioperative blood glucose and insulin levels were measured in children (1-9 years of age) randomly assigned to two groups according to anesthesia technique, general anesthesia (group GA) or general anesthesia combined with regional anesthesia (group RA). Children in the GA group (n = 10) received halothane and opioids, while children of the RA group received epidural anesthesia with bupivacaine (0.25%) and adrenaline combined with halothane anesthesia (n = 10). Children in both groups received 2.5% dextrose in 0.4 N saline administered by volumetric infusion pumps throughout the study period, the infusion rate being adapted to the child's age. Blood samples for glucose and insulin determinations were obtained: at induction, at the end of surgery, and 30, 60 and 120 min after surgery. In response to an identical glucose load, blood glucose levels increased significantly in both groups (P < 0.001), while no differences between groups were observed. Insulin levels did not change significantly postoperatively in the GA group (P = 0.058), while a significant increase was observed in the RA group (P < 0.001). Insulin/blood glucose ratio increased significantly only in the RA group (P < 0.05). The higher insulin secretion in response to glucose infusion in the RA group compared to the GA group may indicate an increased peripheral insulin resistance after regional anesthesia or, more likely, this secretion may be beneficial in contributing to improve postoperative nitrogen balance.
Gouyet
I
I
Department of Pediatric Anesthesia, Hôpital Saint-Vincent de Paul, Paris, France.
Dubois
M C
MC
Murat
I
I
Saint-Maurice
C
C
D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D001786:Blood Glucose / Q000502:physiology*; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007328:Insulin / Q000502:physiology*; D013514:Surgical Procedures, Operative
D001786:Blood Glucose; D007328:Insulin; D005947:Glucose