title: Spinal anesthesia protects against perioperative hyperglycemia in patients undergoing hip arthroplasty.
abstract: OBJECTIVE
  To determine whether spinal anesthesia blunts surgical stress reactions and results in less perioperative hyperglycemia.
  
  
  METHODS
  Prospective, randomized controlled study.
  
  
  METHODS
  Operating room of a university hospital.
  
  
  METHODS
  68 adult, nondiabetic (n = 40) and diabetic (n = 28), ASA physical status 1, 2, and 3 patients patients undergoing elective total hip replacement.
  
  
  METHODS
  General or spinal anesthesia was administered.
  
  
  METHODS
  Blood HbA1C was measured preoperatively to identify patients with undiagnosed diabetes. Glucose levels were checked preoperatively, then immediately after, and one hour after surgery. A conventional glucose control protocol was used, where insulin was given when blood glucose concentrations exceeded 250 mg/dL.
  
  
  RESULTS
  Preoperative glucose levels in general and spinal anesthesia patients were comparable and not significantly different in nondiabetic and diabetic patients. At the end of surgery and one hour after surgery, glucose levels were significantly higher in patients undergoing general anesthesia compared with baseline values in both diabetic and nondiabetic patients (P < 0.05). In nondiabetic and diabetic patients, a significant increase in glucose level was found in patients undergoing general anesthesia versus spinal anesthesia (P < 0.05). In patients receiving spinal anesthesia, glucose levels remained stable. Two diabetic patients undergoing general anesthesia received insulin.
  
  
  CONCLUSIONS
  Spinal anesthesia attenuates the hyperglycemic response to surgical stimuli in diabetics and nondiabetic patients.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, 48149 Münster, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Gottschalk
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Knappschaftskrankenhaus Bochum-Langendreer, University Hospital Bochum, 44789 Bochum, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Rink
authors.affiliation: Department of Trauma Surgery, Knappschaftskrankenhaus Bochum-Langendreer, University Hospital Bochum, 44789 Bochum, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Smektala
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Knappschaftskrankenhaus Bochum-Langendreer, University Hospital Bochum, 44789 Bochum, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Piontek
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, 48149 Münster, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Ellger
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Knappschaftskrankenhaus Bochum-Langendreer, University Hospital Bochum, 44789 Bochum, Germany; Department of Anesthesiology, Intensive Care and Pain Medicine, Diakoniekrankenhaus Friederikenstift, 30169 Hannover, Germany. Electronic address: andre.gottschalk@ddh-gruppe.de.
authors.forename: André
authors.initials: A
authors.lastname: Gottschalk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D000775:Anesthesia, Spinal / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism; D048909:Diabetes Complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000097:blood; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Diabestes; General anesthesia; Hyperglycemia; Spinal anesthesia; Total hip replacement