Time of peritoneal cavity exposure influences postoperative glucose production.
OBJECTIVE
To examine the effect of the duration of peritoneal cavity exposure on glucose metabolism after abdominal surgery.


METHODS
In eight otherwise healthy patients (ASA 1) with uterine myoma, endogenous glucose production (Ra glucose) was measured immediately before and two hours after abdominal hysterectomy by a stable isotope dilution technique using primed continuous infusions of [6,6-2H2]-glucose. Plasma concentrations of glucose, lactate, insulin, glucagon, cortisol, epinephrine and norepinephrine were determined before, during (5 and 60 min after peritoneal incision, skin closure) and two hours after surgery. Pre- and postoperative glucose clearance was calculated as Ra glucose divided by plasma glucose concentration.


RESULTS
Ra glucose increased from 11.8 +/- 1.2 to 16.8 +/- 3.2 micromol x kg(-1) x min(-1) two hours after hysterectomy (P < 0.05) with a correlation between the degree of increase and the time of peritoneal cavity exposure (r = 0.859, P = 0.006). Plasma glucose concentration increased after surgery from 4.7 +/- 0.8 to 8.3 +/- 1.9 mmol x l(-1) (P < 0.05), while glucose clearance decreased from 2.6 +/- 0.4 to 2.1 +/- 0.4 ml x kg(-1) x min(-1) (P < 0.05). Plasma concentrations of cortisol and catecholamines increased after hysterectomy (cortisol from 6 +/- 2 to 31 +/- 7 microg x dl(-1), epinephrine from 25 +/- 14 to 205 +/- 132 pg x ml(-1), norepinephrine from 182 +/- 82 to 377 +/- 132 pg x ml(-1), P < 0.05), whereas plasma lactate, insulin and glucagon concentrations remained unchanged.


CONCLUSIONS
The magnitude of increase of glucose production after abdominal hysterectomy is associated with the duration of peritoneal cavity exposure.
Schricker
T
T
Department of Anesthesia, Royal Victoria Hospital, Montreal, Quebec, Canada. mbek@musica.mcgill.ca
Carli
F
F
Schreiber
M
M
Laftermann
R
R
Georgieff
M
M
D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis; D002851:Chromatography, High Pressure Liquid; D003903:Deuterium; D004837:Epinephrine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D008401:Gas Chromatography-Mass Spectrometry; D005934:Glucagon / Q000097:blood; D005947:Glucose / Q000008:administration & dosage / Q000378:metabolism*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007044:Hysterectomy; D007201:Indicator Dilution Techniques; D007262:Infusions, Intravenous; D007328:Insulin / Q000097:blood; D007773:Lactates / Q000097:blood; D007889:Leiomyoma / Q000601:surgery; D016014:Linear Models; D009638:Norepinephrine / Q000097:blood; D010529:Peritoneal Cavity / Q000601:surgery*; D011863:Radioimmunoassay; D013997:Time Factors; D014594:Uterine Neoplasms / Q000601:surgery
D001786:Blood Glucose; D007328:Insulin; D007773:Lactates; D005934:Glucagon; D003903:Deuterium; D005947:Glucose; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine