GLUCOSE-INFUSION INSTEAD OF PREOPERATIVE FASTING REDUCES POSTOPERATIVE INSULIN-RESISTANCE

In severe catabolic states, such as burn injury, sepsis and accidental injury, a state of marked insulin resistance is encountered. Insulin resistance is also present after elective surgical treatment, more pro nounced with increasingly greater magnitude of operation performed. Re sults of recent animal experiments have shown that even short periods of food deprivation, reducing carbohydrate reserves, alter responses t o stress. This notion resulted in our questioning the rationale of car bohydrate depletion associated with overnight preoperative fasting; Tw elve patients undergoing elective open cholecystectomy were randomly g iven no infusion (control group) or 5 milligrams per kilogram per minu te of glucose infusion (glucose group) during preoperative overnight f asting. Insulin sensitivity (M value, milligram per kilogram per minut e) was determined using the hyperinsulinemic normoglycemic clamp (plas ma insulin level, 65 microunits per milliliter and blood glucose level , 4.5 millimoles per liter) before and the first postoperative day. Pr eoperative insulin sensitivity was similar in the two groups. Postoper atively, M values decreased by 55 +/- 3 percent (control group) and by 32 +/- 4 percent (glucose group) (p<0.01). Plasma levels of insulin, c-peptide, glucagon, growth hormone, catecholamines and cortisol in co nnection with clamps were similar in both groups preoperatively and po stoperatively. The present results indicate that active preoperative c arbohydrate preservation may improve postoperative metabolism because postoperative occurrence of insulin resistance was reduced with preope rative glucose infusion.