Continuous post-operative blood glucose monitoring and control using a closed-loop system in patients undergoing hepatic resection.
OBJECTIVE
Hyperglycemia induced by surgical stress often causes the dysregulation of liver metabolism and immune function resulting in impaired post-operative recovery. The aim of this study was to evaluate the usefulness of a closed-loop system providing continuous monitoring and strict control of post-operative blood glucose in patients after hepatic resection.


METHODS
A total of 19 patients who underwent hepatic resection for primary liver tumor between August and December 2006 were enrolled in the study. Following surgery, blood glucose was continuously monitored by the STG-22 closed-loop system. Glucose levels were controlled using either a manual injection of insulin according to the commonly used sliding scale (manual insulin group, n = 9) or a programmed infusion of insulin determined by the control algorithm of the STG-22 (programmed insulin group, n = 10). The total amount of insulin used in the first 16 h following hepatic resection in the two groups was measured.


RESULTS
In the manual insulin group, post-operative blood glucose rose initially and reached a plateau of approximately 250 mg/dl between 4 h and 7 h post-hepatectomy and then returned towards normal levels by 16 h. In the programmed insulin group, blood glucose was steadily lowered, reaching the target zone (90-110 mg/dl) by 12 h post-surgery. The total amount of insulin administered per patient during the first 16 h post-surgery was significantly higher in the programmed insulin group (183 +/- 188 IU) than in the manual insulin group (8 +/- 7 IU; P < 0.001). No hypoglycemia was observed in either group.


CONCLUSIONS
Post-operative hyperglycemia was observed for up to 16 h in hepatectomized patients. In this post-operative hyperglycemic state, the STG-22 closed-loop system safely and quickly achieved glycemic control, indicating its clinical value in the post-operative management of hepatectomized patients.
Okabayashi
Takehiro
T
Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku City, Kochi, Japan. tokabaya@kochi-u.ac.jp
Hnazaki
Kazuhiro
K
Nishimori
Isao
I
Sugimoto
Takeki
T
Maeda
Hiromichi
H
Yatabe
Tomoaki
T
Dabanaka
Ken
K
Kobayashi
Michiya
M
Yamashita
Koichi
K
D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000209:etiology; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D011183:Postoperative Complications / Q000175:diagnosis*
D001786:Blood Glucose