Effect of desflurane/remifentanil anaesthesia on glucose metabolism during surgery: a comparison with desflurane/epidural anaesthesia.
BACKGROUND
The aim of this study was to investigate the effect of general anaesthesia combined with remifentanil or epidural blockade on glucose metabolism during surgery.


METHODS
We randomly assigned patients undergoing elective colorectal surgery to receive either desflurane anaesthesia supplemented with intravenous remifentanil (n = 7) or desflurane anaesthesia supplemented with epidural bupivacaine (n = 7). Plasma concentrations of glucose, lactate, free fatty acids (FFA), insulin, glucagon and cortisol were measured before and after 2 h of surgery. Pre- and intraoperative whole body glucose production and glucose clearance, an indicator of glucose uptake, were determined by an isotope dilution technique using [6,6-2H2]glucose.


RESULTS
In both groups intraoperative glucose production ( P< 0.05) and uptake ( P< 0.05) decreased. Plasma glucose concentrations ( P< 0.05) increased during surgery but did not exceed the normal range (remifentanil group: 5.7 +/- 0.7 mmol l-1, epidural group: 5.8 +/- 0.4 mmol l-1). The plasma concentrations of lactate, FFA, insulin and glucagon remained unchanged during the operation. The plasma cortisol concentration in both groups increased intraoperatively (P< 0.05).


CONCLUSIONS
Both desflurane/remifentanil and desflurane/epidural anaesthesia decrease the intraoperative rate of whole body glucose production, thereby attenuating the hyperglycaemic response to colorectal surgery.
Schricker
T
T
Department of Anaesthesia, McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, Rm. S5.05, Montreal, Quebec, Canada H3A 1A1. thomas.schricker@mcgill.ca
Galeone
M
M
Wykes
L
L
Carli
F
F
D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural; D003082:Colectomy; D000077335:Desflurane; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology*; D000077208:Remifentanil
D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D005947:Glucose; D000077208:Remifentanil