Effects of intraoperative glucose administration on circulating metabolites and nitrogen balance during prolonged surgery

Study Objectives: To compare the effects of intraoperative administration o f 2.5% glucose or Ringer's solution on metabolism during prolonged surgery. Design: Prospective, randomized study. Setting: Teaching hospital. Patients: 20 ASA physical status I and II adults patients scheduled for tho racic or abdominal surgery lasting at least 3 hours. Interventions: Patients received Ringer's solution (Group R) or 2.5% glucos e solution (Group G) 10 ml.kg(-1).h(-1) during surgery and 2 ml.kg.(-1).h-1 during the first two postoperative hours (Ringer's or glucose), then 40 ml .kg.(- 1).day(-1) of 5% intravenous (IV) glucose postoperatively. Measurements and Main Results: Plasma glucose, free fatty acids, ketone bod ies, lactate, insulin, glucagon, cortisol, and growth hormone concentration s were determined after an overnight fast (T-0), on induction of anesthesia (T-1), at the end of surgery (T-2), 2 hours thereafter (T-3), and on the f ollowing morning (T-4). Capillary blood gluvose was determined every 30 min utes from T-1 to T-2. Urinary nitrogen and 3-methylhistidine were measured every day for 5 days. There were no differences between groups in demograph ic data, anesthesia, or surgical procedures. All data were comparable at ba seline and on the following morning. In Group R, no patient expeienced hypo glycemia, but plasma fatty acids and ketone bodies increased during surgery . In Group G, glycemia rose to very high levels, with a significant increas e in insulin during surgery. Other hormones were the same within the two gr oups. Urinary nitrogen and 3-methylhistidine were similar in both groups. Conclusion: The absence of glucose infusion in prolonged surgery did not ca use hypoglycemia, and no increase in protein catabolism was observed. (C) 2 000 by Elsevier Science Inc.