title: Effects of intraoperative administration of carbohydrates during long-duration oral and maxillofacial surgery on the metabolism of carbohydrates, proteins, and lipids.
abstract: OBJECTIVE
  Insulin resistance in patients undergoing invasive surgery impairs glucose and lipid metabolism and increases muscle protein catabolism, which may result in delayed recovery and prolonged hospital stay. We examined whether intraoperative administration of carbohydrates during long-duration oral and maxillofacial surgery under general anesthesia affects carbohydrate, proteins, and lipid metabolism and the length of hospital stay.
  
  
  METHODS
  We studied 16 patients with normal liver, kidney, and endocrine functions, and ASA physical status I or II, but without diabetes. Patients were randomly assigned to receive 0.1 g/kg/h of (n = 8) or lactated Ringer's solution (n = 8). Blood was collected before (T0) and 4 h after (T1) the start of surgery. We analyzed the plasma levels of glucose, ketone bodies, 3-methylhistidine (3-MH), and the length of hospital stay.
  
  
  RESULTS
  At T0, no statistically significant differences were observed in the levels of glucose, ketone bodies, and 3-MH between the groups. At T1, no statistically significant difference in glucose levels was found between the groups. However, ketone bodies were significantly lower, and the changes in 3-MH levels were significantly less pronounced in the glucose-treated group compared with controls. No significant differences were observed between the groups in terms of length of hospital stay.
  
  
  CONCLUSIONS
  The administration of low doses of glucose during surgery was safe, did not cause hyperglycemia or hypoglycemia, and inhibited lipid metabolism and protein catabolism. Additional experiments with larger cohorts will be necessary to investigate whether intraoperative management with glucose facilitates postoperative recovery of patients with oral cancer.
authors.affiliation: Department of Dental Anesthesiology, Tsurumi University School of Dental Medicine, 2-1-3, Tsurumi, Tsurumi-ku, Yokohama-shi, Kanagawa, 230-0062, Japan. yamamoto-t@tsurumi-u.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Dental Anesthesiology, Hiroshima University, Hiroshima, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Dental Anesthesiology, Kyushu Dental University, Kitakyushu, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Department of Dental Anesthesiology, Tsurumi University School of Dental Medicine, 2-1-3, Tsurumi, Tsurumi-ku, Yokohama-shi, Kanagawa, 230-0062, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawahara
mesh_terms: D000368:Aged; D050260:Carbohydrate Metabolism / Q000187:drug effects*; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay; D050356:Lipid Metabolism / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D011506:Proteins / Q000378:metabolism*; D013515:Surgery, Oral; D013997:Time Factors
chemical_list: D011506:Proteins; D005947:Glucose
keywords: General anesthesia; Glucose; Intraoperative nutrition; Oral and maxillofacial surgery; Protein catabolism