Time of peritoneal cavity exposure influences postoperative glucose production

Purpose: To examine the effect of the duration of peritoneal cavity exposur e on glucose metabolism after abdominal surgery. Methods: In eight otherwise healthy patients(ASA I) with uterine myoma, end ogenous glucose production (R-a glucose) was measured immediately before an d two hours after abdominal hysterectomy by a stable isotope dilution techn ique using primed continuous infusions of [6,6-H-2(2)]-glucose. Plasma conc entrations of glucose, lactate, insulin, glucagon, cortisol, epinephrine an d norepinephrine were determined before, during (5 and 60 min after periton eal incision, skin closure) and two hours after surgery. Pre- and postopera tive glucose clearance was calculated as R-a glucose divided by plasma gluc ose concentration. Results: R-a glucose increased from 11.8 +/- 1.2 to 16.8 +/- 3.2 mu mol.kg( -1).min(-1) two hours after hysterectomy (P < 0.05) with a correlation betw een the degree of increase and the time of peritoneal cavity exposure (r = 0.859, P = 0.006). Plasma glucose concentration increased after surgery fro m 4.7 +/- 0.8 to 8.3 +/- 1.9 mmol.l(-1) (P < 0.05), while glucose clearance decreased from 2.6 +/- 0.4 to 2.1 +/- 0.4 ml.kg(-1).min(-1) (P < 0.05). Pl asma concentrations of cortisol and catecholamines increased after hysterec tomy (cortisol from 6 +/- 2 to 31 +/- 7 mu g.dl(-1), epinephrine from 25 +/ - 14 to 205 +/- 132 pg.ml(-1), norepinephrine from 182 +/- 82 to 377 +/- 13 2 pg.ml(-1), P < 0.05), whereas plasma lactate, insulin and glucagon concen trations remained unchanged. Conclusion: The magnitude of increase of glucose production after abdominal hysterectomy is associated with the duration of peritoneal cavity exposure .