Effects of Glucose Load on Catabolism during Propofol-Based Anesthesia with Remifentanil in Patients with Diabetes Mellitus: A Prospective Randomized Trial

Tomotsugu Yamada, Maiko Hasegawa-Moriyama^*, Mayumi Nakahara, Akira Matsunaga, Yuichi Kanmura

Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.

DOI: 10.4236/ojanes.2015.59036                

Abstract

Background: Perioperative exacerbation of hyperglycemia and insulin resistance is associated with increased complications in patients with diabetes mellitus. We recently reported that glucose load during anesthesia with sevoflurane suppressed lipid catabolism in diabetic patients. In contrast to inhaled anesthetics, propofol solution contains triglycerides, which can be an energy source during surgery. However, the clinical relevance of glucose load under propofol-based anesthesia in diabetic patients is unknown. Therefore, we investigated the effect of intraoperative glucose load on catabolism during propofol-based anesthesia in patients with diabetes mellitus. Methods: Twenty-three patients with diabetes mellitus undergoing elective surgery with propofol-remifentanil-based anesthesia were randomly assigned to receive a glucose load (1.5 mg/kg/ min) or not. Plasma levels of glucose, insulin, cortisol, catecholamines, acetoacetic acid, free fatty acids, ketone bodies, 3-hydroxybutyric acid, and 3-methylhistidine/creatinine, used as a marker for protein catabolism, were measured at the start of surgery and 3 h later. Results: Glucose and insulin levels were significantly higher in patients who received a glucose load than in those who did not. Nonetheless, the levels of cortisol and catecholamines were unchanged during surgery. Similarly, the difference in the levels of markers for lipid as well as protein catabolism was not significant between the groups at 3 h after the start of surgery. Conclusions: Changes in lipid as well as protein catabolism were not altered by glucose load in diabetic patients under propofol-based anesthesia with remifentanil. Our study suggested that continuous infusion of propofol at a clinical dose is sufficient to reduce the requirement for glucose infusion during surgery in patients with diabetes.

Keywords

Diabetes, Propofol, Glucose Infusion, Catabolism

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Pomposelli, J.J., Baxter 3rd, J.K., Babineau, T.J., Pomfret, E.A., Driscoll, D.F., Forse, R.A. and Bistrian, B.R. (1998) Early Postoperative Glucose Control Predicts Nosocomial Infection Rate in Diabetic Patients. JPEN Journal of Parenteral and Enteral Nutrition, 22, 77-81. http://dx.doi.org/10.1177/014860719802200277
[2]	Kambe, N., Tanaka, K., Kakuta, N., Kawanishi, R. and Tsutsumi, Y.M. (2014) The Influence of Glucose Load on Metabolism during Minor Surgery Using Remifentanil-Induced Anesthesia. Acta Anaesthesiol Scand, 58, 948-954. http://dx.doi.org/10.1111/aas.12335
[3]	Hasegawa-Moriyama, M., Nakahara, M., Saito, T., Yamada, T., Mukaihara, K., Masuda, M., Matsunaga, A. and Kanmura, Y. (2015) The Effects of Glucose Load on Catabolism during Remifentanil-Based Anesthesia in Patients with Diabetes Mellitus: A Prospective Randomized Trial. Open Journal of Anesthesiology, 5, 155-162.
[4]	Oliver, M.F. (2006) Sudden Cardiac Death: The Lost Fatty acid Hypothesis. QJM, 99, 701-709. http://dx.doi.org/10.1093/qjmed/hcl084
[5]	Schricker, T., Carli, F., Schreiber, M., Wachter, U., Geisser, W., Lattermann, R. and Georgieff, M. (2000) Propofol/ Sufentanil Anesthesia Suppresses the Metabolic and Endocrine Response during, Not after, Lower Abdominal Surgery. Anesthesia and Analgesia, 90, 450-455.
[6]	Nygren, J. (2006) The Metabolic Effects of Fasting and Surgery. Best Practice & Research Clinical Anaesthesiology, 20, 429-438. http://dx.doi.org/10.1016/j.bpa.2006.02.004
[7]	Yamasaki, K., Inagaki, Y., Mochida, S., Funaki, K., Takahashi, S. and Sakamoto, S. (2010) Effect of Intraoperative Acetated Ringer’s Solution with 1% Glucose on Glucose and Protein Metabolism. Journal of Anesthesia, 24, 426-431. http://dx.doi.org/10.1007/s00540-010-0926-1
[8]	Behdad, S., Mortazavizadeh, A., Ayatollahi, V., Khadiv, Z. and Khalilzadeh, S. (2014) The Effects of Propofol and Isoflurane on Blood Glucose during Abdominal Hysterectomy in Diabetic Patients. Diabetes & Metabolism Journal, 38, 311-316. http://dx.doi.org/10.4093/dmj.2014.38.4.311
[9]	Ward, D.S., Norton, J.R., Guivarc’h, P.H., Litman, R.S. and Bailey, P.L. (2002) Pharmacodynamics and Pharmacokinetics of Propofol in a Medium-Chain Triglyceride Emulsion. Anesthesiology, 97, 1401-1408.
[10]	Johnson, R.C.C.R. (1986) Metabolism of Medium-Chain Triglyceride Lipid Emulsion. Nutrition International, 2, 150-158.
[11]	Nagao, Y., Tatara, T., Fujita, K., Sugi, T., Kotani, J. and Hirose, M. (2013) Protein Sparing during General Anesthesia with a Propofol Solution Containing Medium-Chain Triglycerides for Gastrectomy: Comparison with Sevoflurane Anesthesia. Journal of Anesthesia, 27, 359-365. http://dx.doi.org/10.1007/s00540-012-1546-8
[12]	Cok, O.Y., Ozkose, Z., Pasaoglu, H. and Yardim, S. (2011) Glucose Response during Craniotomy: Propofol-Remifentanil versus Isoflurane-Remifentanil. Minerva Anestesiologica, 77, 1141-1148.
[13]	Taniguchi, H., Sasaki, T., Fujita, H., Takano, O., Hayashi, T., Cho, H., Yoshikawa, T. and Tsuburaya, A. (2013) The Effect of Intraoperative Use of High-Dose Remifentanil on Postoperative Insulin Resistance and Muscle Protein Catabolism: A Randomized Controlled Study. International Journal of Medical Sciences, 10, 1099-1107. http://dx.doi.org/10.7150/ijms.5924