title: Intra-operative administration of low-dose IV glucose attenuates post-operative insulin resistance.
abstract: OBJECTIVE
  Insulin sensitivity often decreases after surgery in spite of normal insulin secretion, and may worsen the outcome. This post-operative insulin resistance increases according to the magnitude of surgical invasion. However, supplementation of carbohydrates before surgery attenuates the post-operative insulin resistance. This study aimed to investigate the effect of intra-operative administration of low-dose glucose on the post-operative insulin resistance.
  
  
  METHODS
  Patients undergoing maxillofacial surgery were randomly assigned to two groups throughout the surgical procedure: The glucose group receiving acetated Ringer solution with 1.5% glucose and the control group receiving acetated Ringer solution without glucose. Insulin resistance quantified by the mean glucose infusion rate (the glucose infusion rate) was evaluated by glucose clamp using the STG-22TM instrument on the previous day and on the next day of surgery. Blood glucose level was monitored continuously during surgery. In addition, serum insulin, ketone bodies and 3-methylhistidine were measured during perioperative period.
  
  
  RESULTS
  Patients in the glucose group (n=11) received 0.15 ± 0.06 g/kg/h of glucose during surgery, while patients in the control group (n=11) received no glucose. In both groups, however, the mean blood glucose levels were maintained stable at less than 150 mg/dL during and after surgery. The serum ketone bodies significantly increased after surgery in the control group (p=0.0035), while it decreased significantly in the glucose group (p=0.043). The reduction rate in the glucose infusion rate was significantly lower in the glucose group, 43.3 ± 20.7%, than that in the control group, 57.7 ± 9.3% (p=0.041).
  
  
  CONCLUSIONS
  Intra-operative small-dose of glucose administration may suppress ketogenesis and attenuate the post-operative insulin resistance without causing hyperglycemia.
authors.affiliation: Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. yokoyama@dent.kyushu-u.ac.jp.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Fujino
authors.forename: Shoko
authors.initials: S
authors.lastname: Itoda
authors.forename: Kanako
authors.initials: K
authors.lastname: Esaki
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsukamoto
authors.forename: Saori
authors.initials: S
authors.lastname: Sako
authors.forename: Kazuki
authors.initials: K
authors.lastname: Matsuo
authors.forename: Eiji
authors.initials: E
authors.lastname: Sakamoto
authors.forename: Kunio
authors.initials: K
authors.lastname: Suwa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yokoyama
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D001786:Blood Glucose; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000494:pharmacology*; D015309:Glucose Clamp Technique / Q000379:methods; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D007430:Intraoperative Care / Q000379:methods*; D007552:Isotonic Solutions / Q000008:administration & dosage; D007657:Ketone Bodies / Q000097:blood; D008297:Male; D008762:Methylhistidines / Q000097:blood; D011183:Postoperative Complications / Q000517:prevention & control*; D011184:Postoperative Period; D000077331:Ringer's Solution
chemical_list: D001786:Blood Glucose; D007328:Insulin; D007552:Isotonic Solutions; D007657:Ketone Bodies; D008762:Methylhistidines; D000077331:Ringer's Solution; D005947:Glucose; C028118:3-methylhistidine