Time of peritoneal cavity exposure influences postoperative glucose production

Abstract

Purpose: To examine the effect of the duration of peritoneal cavity exposure on glucose metabolism after abdominal surgery. Methods: In eight otherwise healthy patients (ASA I) with uterine myoma, endogenous glucose production (R(a) glucose) was measured immediately before and two hours after abdominal hysterectomy by a stable isotope dilution technique using primed continuous infusions of [6,6-2H2]-glucose. Plasma concentrations of glucose, lactate, insulin, glucagon, cortisol, epinephrine and norepinephrine were determined before, during (5 and 60 min after peritoneal incision, skin closure) and two hours after surgery. Pre- and postoperative glucose clearance was calculated as R glucose divided by plasma glucose concentration. Results: R(a) glucose increased from I 1.8 ± 1.2 to 16.8 ± 3.2 μmol·kg-1·min-1 two hours after hysterectomy (P < 0.05) with a correlation between the degree of increase and the time of peritoneal cavity exposure (r = 0.859, P = 0.006). Plasma glucose concentration increased after surgery from 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). Plasma concentrations of cortisol and catecholamines increased after hysterectomy (cortisol from 6 ± 2 to 31 ± 7 μg·dl-1, epinephrine from 25 ± 14 to 205 ± 132 pg·ml-1, norepinephrine from 182 ± 82 to 377 ± 132 pg·ml-1, P < 0.05), whereas plasma lactate, insulin and glucagon concentrations remained unchanged. Conclusion: The magnitude of increase of glucose production after abdominal hysterectomy is associated with the duration of peritoneal cavity exposure.