Hypoglycemia in Laparoscopic Colectomy with Remifentanil Use and Preoperative Intravenous Glucose Infusion: A Prospective, Randomized, Single-Blind, Controlled Trial

Abstract

Background: The profound effect of a minimally-invasive procedure under general anesthesia with remifentanil contributes to suppression of hyperglycemic responses, which was formerly observed as a stress response. However, intraoperative occurrence of hypoglycemia is considered more of a concern. In addition, depending on preoperative nutritional status, critical hypoglycemia may occur during surgery. There are few reports on perioperative glucose metabolism in patients not receiving glucose infusion under anesthesia with remifentanil. The preoperative fasting period is longer in Japan and preoperative carbohydrate infusion or other pretreatment is not actively performed; thus, the preoperative nutritional status is close to that of starvation. Furthermore, the regulation of glucose metabolism under intraoperative management with potent opioids, such as remifentanil, as well as the fluctuations in metabolism due to perioperative glucose infusion, is important from the viewpoint of nutritional management. Objective: This study aimed to examine the impact of preoperative intravenous glucose infusion on glucose, lipid, and protein metabolism before and after surgery under general anesthesia with remifentanil. Methods: Forty patients who were scheduled for elective laparoscopic colectomy were randomly assigned to 2 groups: a glucose group that received 1500 mL of a maintenance solution with 10% glucose (glucose 150 g) and a non-glucose group that received the same amount of an extracellular solution without glucose. Glucose metabolism during and after surgery (blood glucose levels, insulin, C-peptide), lipid metabolism (ketone body fractions, free fatty acids), and protein metabolism (urinary 3-methyhistidine) were also evaluated. Results: No changes were found in background in either group. Blood glucose levels during surgery remained significantly lower (P=0.003) in the control group than in the glucose group. One patient had a blood glucose level below 40 mg/dL, and 6 patients had blood glucose levels below 60 mg/dL. Lipid catabolism increased before the induction of anesthesia. Conclusion: The incidence of hypoglycemia and the rate of lipid catabolism would increase before the induction of anesthesia and during surgery in elective laparoscopic colectomy using remifentanil without glucose infusion.