Kamuro H, Komorita N, Ogawa R
Osaka Laboratories, Pharmaceutical Research Division, Yoshitomi Pharmaceutical Industries, 2-25-1 Shodai-Ohtani, Hirakata, Osaka 573-1153, Japan.
J Anesth. 2000 Jan 20;14(1):19-23. doi: 10.1007/s005400050004.
We examined preoperative glucose administration to establish what dose and cutoff point were optimal for suppression of lipolysis and prevention of hypo- or hyperglycemia.
Rabbits were preoperatively fasted and simultaneously received glucose at a constant rate of 0, 0.1, 0.2, 0.3, or 0.4 g.kg(-1).h(-1) in fluid infusion for 3 h. Plasma glucose, immunoreactive insulin activity, nonesterified fatty acids, and ketone bodies were measured 0, 1.5, 3 and 4 h after the start of infusion, and hepatic glycogen content was assessed 1 h after cessation of infusion.
Fluid infusion without glucose decreased plasma glucose. Glucose administration at more than 0.2 g.kg(-1).h(-1) caused hyperglycemia (>200 mg.dl(-1)) in the infusion period; the differences were significant compared with the value at zero time or in the 0 g.kg(-1).h(-1) group (P < 0.01). The highest dose also raised plasma immunoreactive insulin activity, which was significantly higher than in the 0 g.kg(-1).h(-1) group (P < 0.01) at the midpoint of the infusion period. Plasma nonesterified fatty acids increased in all groups. The changes were, however, significantly reduced in both the 0.3 and 0.4 g.kg(-1).h(-1) groups (P < 0.05 and P < 0.01, respectively) by the end of infusion. All these effects of glucose supply, including suppression of lipolysis, disappeared regardless of dose within 1 h after the cessation of infusion.
These results suggest that the optimal dose for preoperative glucose infusion, in order to preserve carbohydrate or fat metabolism, is 0.1-0.2 or 0.3 g.kg(-1).h(-1), respectively, and indicate that administration should not be discontinued until the start of surgery.
