GLUCOSE-INTOLERANCE DURING PROLONGED SEVOFLURANE ANESTHESIA

Purpose: The effects of prolonged sevoflurane anaesthesia on insulin s ensitivity were investigated by two successive intravenous glucose tol erance tests (IVGTT) in eight patients who underwent prolonged surgery . Methods: The first IVGTT was administered (25 g glucose as 20% dextr ose in water iv) over two minutes 35 min after initiation of surgery. Arterial blood samples were obtained at 0, 5, 10, 30, 60, and 120 min after glucose administration for blood glucose and plasma insulin dete rmination. A second IVGTT was performed six hours following the initia tion of surgery. Results: The disappearance rate of glucose (k-value) for the first IVGTT was 0.887 +/- 0.43.6 (mean +/- SD) %. min(-1), and 0.784 +/- 0.289 for the second IVGTT. Both k-values are lower than th e normal value. The maximum insulin response to glucose (Delta IRI .De lta BS-1) of the second IVGTT was lower than the first IVGTT (0.124 +/ - 0.092 vs 0.071 +/- 0.056, P < 0.05). The total insulin output of the first IVGTT was higher than the sec ond IVGTT (1,161 +/- 830 vs 568 /- 389 mu U . min . ml(-1), P < 0.05). Conclusion: Glucose intolerance is enhanced by diminished insulin output in response to blood glucose elevation during prolonged anaesthesia and surgery.