Journal of Anesthesia

, Volume 24, Issue 3, pp 426–431

Effect of intraoperative acetated Ringer’s solution with 1% glucose on glucose and protein metabolism

  • Kazumasa Yamasaki
  • Yoshimi Inagaki
  • Shinsuke Mochida
  • Kazumi Funaki
  • Shunsaku Takahashi
  • Seiji Sakamoto
Original Article

Abstract

Purpose

To investigate the effects of the intraoperative administration of Ringer’s solution with 1% glucose on the metabolism of glucose, lipid and muscle protein during surgery.

Methods

Thirty-one adult patients, American Society of Anesthesiologists physical status I or II, undergoing elective otorhinolaryngeal, head and neck surgeries were randomly assigned to one of two patient groups: those receiving acetated Ringer’s solution with 1% glucose (Group G) or those receiving acetated Ringer’s solution without glucose (Group R) throughout the surgical procedure. Plasma glucose was measured at anesthetic induction (T0), artery 1 h (T1), 2 h (T2), 3 h after anesthetic induction (T3) and at the end of surgery (T4). Plasma ketone bodies, insulin and 3-methylhistidine were measured at T0 and T4.

Results

The intravenous infusion for patients in Group G and R was 6.1 ± 0.8 and 6.3 ± 1.7 ml/kg/h, respectively, with Group G patients receiving a dose of 4.1 g/h glucose. Plasma glucose levels were significantly higher in Group G than in Group R patients at T1, T2, T3 and T4; however, plasma glucose remained <150 mg/dl in both groups. The plasma concentration of ketone bodies was significantly higher (P < 0.05) in Group R than in Group G patients at T4. Changes in plasma 3-methylhistidine concentration was significantly lower in Group G than in Group R patients. These results indicate that acetated Ringer’s solution with 1% glucose decreased protein catabolism without hyperglycemia among the Group G patients.

Conclusion

The infusion of a small dose of glucose (1%) during minor otorhinolaryngeal, head and neck surgeries may suppress protein catabolism without hyperglycemia and hypoglycemia.

Keywords

Glucose Intraoperative nutrition 3-Methylhistidine Protein metabolism 

References

  1. 1.
    Sieber FE, Smith DS, Traystman RJ, Wolman H. Glucose: a reevaluation of its intraoperative use. Anesthesiology. 1987;67:72–81.CrossRefPubMedGoogle Scholar
  2. 2.
    Weissman C. The metabolic response to stress: an overview and update. Anesthesiology. 1990;73:308–27.CrossRefPubMedGoogle Scholar
  3. 3.
    Sieber FE, Smith DS, Kupferberg J, Crosby L, Uzzell B, Buzby G, March K, Nann L. Effects of intraoperative glucose on protein catabolism and plasma glucose levels in patients with supratentorial tumors. Anesthesiology. 1986;64:453–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Walsh ES, Traynor C, Paterson JL, Hall GM. Effect of different intraoperative fluid regimens on circulating metabolites and insulin during abdominal surgery. Anaesthesia. 1983;55:135–9.CrossRefGoogle Scholar
  5. 5.
    Lattermann R, Carli F. Perioperative glucose infusion and the catabolic response to surgery: the effect of epidural block. Anesth Analg. 2003;96:555–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Nygren J, Thorell A, Efendic S, Nair KS, Ljungqvist O. Site of insulin resistance after surgery: the contribution of hypocaloric nutrition and bed rest. Clin Sci. 1997;93:137–46.PubMedGoogle Scholar
  7. 7.
    Chambrier C, Aouifi A, Bon C, Saudin F, Paturel B, Boulétreau P. Effects of intraoperative glucose administration on circulating metabolites and nitrogen balance during prolonged surgery. J Clin Anesth. 1999;11:646–51.CrossRefPubMedGoogle Scholar
  8. 8.
    Nair KS, Woolf PD, Welle SL, Matthews DE. Leucine, glucose, and energy metabolism after 3 days of fasting in healthy human subjects. Am J Clin Nutr. 1987;46:557–62.PubMedGoogle Scholar
  9. 9.
    Lund J, Stjernstrom H, Bergholm U. The exchange of blood-borne amino acids in the leg during abdominal surgical trauma: effects of glucose infusion. Clin Sci. 1986;71:487–96.PubMedGoogle Scholar
  10. 10.
    Obata K, Ogata M, Matsumoto T, Takenaka I, Sata T, Shigematsu A. The effect of glucose on plasma amino acids and pyruvate during upper abdominal surgery. Anesth Analg. 1993;76:357–61.PubMedGoogle Scholar
  11. 11.
    Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63:356–61.CrossRefPubMedGoogle Scholar
  12. 12.
    Ouattara A, Lecomte P, Yannick LM, Landi M, Jacqueminet S, Platonov I, Bonnet N, Riou B, Coriat P. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology. 2005;103:687–94.CrossRefPubMedGoogle Scholar
  13. 13.
    Rady MY, Ryan T, Starr NJ. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med. 1998;26:225–35.CrossRefPubMedGoogle Scholar
  14. 14.
    van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.CrossRefPubMedGoogle Scholar
  15. 15.
    Finney SJ, Zekveld C, Elia A, Evans TW. Glucose control and mortality in critically ill patient. JAMA. 2003;290:2041–7.CrossRefPubMedGoogle Scholar
  16. 16.
    NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.CrossRefGoogle Scholar
  17. 17.
    Tsubo T, Kudo T, Matsuki A, Oyama T. Decreased glucose utilization during prolonged anaesthesia and surgery. Can J Anaesth. 1990;37:645–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Black PR, Brooks DC, Bessey PQ, Wolfe RR, Wilmore DW. Mechanisms of insulin resistance following injury. Ann Surg. 1982;196:420–33.CrossRefPubMedGoogle Scholar
  19. 19.
    Gump FE, Long C, Killian P, Kinney JM. Studies of glucose intolerance in septic injured patients. J Trauma. 1974;14:378–87.CrossRefPubMedGoogle Scholar
  20. 20.
    O’Connell RC, Morgan AP, Aoki TT, Ball MR, Moore FD. Nitrogen conservation in starvation: graded responses to intravenous glucose. J Clin Endocrinol Metab. 1974;39:555–62.CrossRefPubMedGoogle Scholar
  21. 21.
    Crowe PJ, Dennison A, Royle GT. The effect of pre-operative glucose loading on postoperative nitrogen metabolism. Br J Surg. 1984;71:635–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Blackburn GL, Flatt JP, Clowes GHA, O’Donnell TF, Hensle TE. Protein sparing therapy during periods of starvation with sepsis or trauma. Ann Surg. 1974;177:588–94.CrossRefGoogle Scholar
  23. 23.
    Nagasawa T, Yoshizawa F, Nishizawa N. Plasma N tau-methylhistidine concentration is a sensitive index of myofibrillar protein degradation during starvation in rats. Biosci Biotech Biochem. 1996;60:501–2.CrossRefGoogle Scholar
  24. 24.
    Neuhauser M, Bassler KH. Endogenous 3-methylhistidine excretion in healthy women and men with reference to muscle protein metabolism. Z Ernaehrungswiss. 1984;23:171–80.CrossRefGoogle Scholar
  25. 25.
    Lowry SF, Horowitz GD, Jeevanandam M, Legaspi A, Brennan MF. Whole-body protein breakdown and 3-methylhistidine excretion during brief fasting, starvation, and intravenous repletion in man. Ann Surg. 1985;202:21–7.CrossRefPubMedGoogle Scholar
  26. 26.
    López-Hellín J, Baena-Fustegueras JA, Vidal M, Riera SS, García-Arumí E. Perioperative nutrition prevents the early protein losses in patients submitted to gastrointestinal surgery. Clin Nutr. 2004;23:1001–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Preedy VR, Paska L, Sugden PH, Schofield PS, Sugden MC. The effects of surgical stress and short-term fasting on protein synthesis in vivo in diverse tissues of the mature rat. Biochem J. 1988;250:179–88.PubMedGoogle Scholar
  28. 28.
    Rennie MJ, Bennegård K, Edén E, Emery PW, Lundholm K. Urinary excretion and efflux from the leg of 3-methylhistidine before and after major surgical operation. Metabolism. 1984;33:250–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Young VR, Munro HN. N′-methylhistidine (3-methylhistidine) and muscle protein turnover: an overview. Federation Proc. 1978;37:2291–300.Google Scholar
  30. 30.
    Long CL, Schaffel N, Geiger JW, Schiller WR, Blakemore WS. Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. J Parenter Enteral Nutr. 1979;3:452–6.CrossRefGoogle Scholar
  31. 31.
    Neuhäuser M, Bergström J, Chao L, Holmström J, Nordlund L, Vinnars E, Fürst P. Urinary excretion of 3-methylhistidine as an index of muscle protein catabolism in post-operative trauma: the effect of parenteral nutrition. Metabolism. 1980;29:1206–13.CrossRefPubMedGoogle Scholar
  32. 32.
    Mikura M, Yamaoka I, Doi M, Kawano Y, Nakayama M, Nakao R, Hirasaka K, Okumura Y, Nikawa T. Glucose infusion suppresses surgery-induced muscle protein breakdown by inhibiting ubiquitin–proteasome pathway in rats. Anesthesiology. 2009;110:81–8.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2010

Authors and Affiliations

  • Kazumasa Yamasaki
    • 1
  • Yoshimi Inagaki
    • 1
  • Shinsuke Mochida
    • 1
  • Kazumi Funaki
    • 1
  • Shunsaku Takahashi
    • 1
  • Seiji Sakamoto
    • 1
  1. 1.Department of Anesthesiology and Critical Care MedicineTottori University Faculty of MedicineYonagoJapan

Personalised recommendations