title: Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative acute kidney injury.
abstract: The aim of the present study was to evaluate the usefulness of a closed-loop system (STG-55; Nikkiso, Tokyo, Japan), a type of artificial endocrine pancreas for the continuous monitoring and control of intraoperative blood glucose, for preventing postoperative acute kidney injury (AKI) in patients undergoing hepatectomy. Thirty-eight patients were enrolled in this study. Glucose concentrations were controlled with either a manual injection of insulin based on a commonly used sliding scale (manual insulin group, n = 19) or the programmed infusion of insulin determined by the control algorithm of the artificial endocrine pancreas (programmed insulin group, n = 19). After the induction of anesthesia, a 20-G intravenous catheter was inserted into the peripheral forearm vein of patients in the programmed insulin group and connected to an artificial endocrine pancreas (STG-55). The target range for glucose concentrations was set to 100-150 mg/dL. The mean serum creatinine concentrations of preoperative, postoperative 24 and 48 h were 0.72, 0.78, and 0.79 mg/dL in the programmed insulin group, and 0.81, 0.95, and 1.03 mg/dL in the manual insulin group, respectively. Elevations in serum creatinine concentrations postoperative 48 h were significantly suppressed in the programmed insulin group. The STG-55 closed-loop system was effective for maintaining strict blood glucose control during hepatectomy with minimal variability in blood glucose concentrations and for suppressing elevations in serum creatinine concentrations. Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative AKI.
authors.affiliation: Department of Anesthesiology, Tokushima University Hospital, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan. mita@tokushima-u.ac.jp.
authors.forename: Naoji
authors.initials: N
authors.lastname: Mita
authors.affiliation: Department of Anesthesiology, Tokushima University Hospital, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan. kawahito.shinji@tokushima-u.ac.jp.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kawahito
authors.affiliation: Department of Anesthesiology, Tokushima University Hospital, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Soga
authors.affiliation: Department of Dental Anesthesiology, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Takaishi
authors.affiliation: Department of Dental Anesthesiology, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitahata
authors.affiliation: Diabetes Therapeutics and Research Center, University of Tokushima, Tokushima, Japan.
authors.forename: Munehide
authors.initials: M
authors.lastname: Matsuhisa
authors.affiliation: Department of Digestive and Pediatric Surgery, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.affiliation: Department of Anesthesiology, Aichi Medical University, Aichi, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Department of Anesthesiology, Tokushima University Hospital, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan.
authors.forename: Yasuo M
authors.initials: YM
authors.lastname: Tsutsumi
authors.affiliation: Department of Anesthesiology, Tokushima University Hospital, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D003404:Creatinine; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D007564:Japan; D008297:Male; D008875:Middle Aged; D019397:Pancreas, Artificial; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin; D003404:Creatinine
keywords: Acute kidney injury; Artificial endocrine pancreas; Continuous blood glucose monitoring; Hepatectomy; Intensive insulin therapy