Abstract
BackgroundPrevious studies showed that remifentanil-induced anesthesia can inhibit surgical stress response in non-diabetic adult patients and that low-dose glucose loading during anesthesia may attenuate fat catabolism. However, little is known about the influence of glucose loading on metabolism in elderly patients, whose condition may be influenced by decreased basal metabolism and increased insulin resistance. We hypothesized that, in elderly patients, intraoperative low glucose infusion may attenuate the catabolism of fat without causing harmful hyperglycemia during remifentanil-induced anesthesia.MethodsElderly, non-diabetic patients scheduled to undergo elective surgery were enrolled and randomized to receive no glucose (0G group) or low-dose glucose infusion (0.1 g/kg/hr. for 1 h followed by 0.05 g/kg/hr. for 1 h; LG group) during surgery. Glucose, adrenocorticotropic hormone (ACTH), 3-methylhistidine (3-MH), insulin, cortisol, free fatty acid (FFA), creatinine (Cr), and ketone body levels were measured pre-anesthesia, 1 h post-glucose infusion, at the end of surgery, and on the following morning.ResultsA total of 31 patients (aged 75–85) were included (0G, n = 16; LG, n = 15). ACTH levels during anesthesia decreased significantly in both groups. In the LG group, glucose levels increased significantly after glucose loading but hyperglycemia was not observed. During surgery, ketone bodies and FFA were significantly lower in the LG group than the 0G group. There were no significant differences in insulin, Cr, 3-MH, and 3-MH/Cr between the two groups.ConclusionRemifentanil-induced anesthesia inhibited surgical stress response in elderly patients. Intraoperative low-dose glucose infusion attenuated catabolism of fat without inducing hyperglycemia.Trial registrationThis study has been registered with the University hospital Medical Information Network Center (http://www.umin.ac.jp/english/). Trial registration number: UMIN000016189. The initial registration date: January 12th 2015.
Highlights
Previous studies showed that remifentanil-induced anesthesia can inhibit surgical stress response in non-diabetic adult patients and that low-dose glucose loading during anesthesia may attenuate fat catabolism
We previously reported that anesthesia using remifentanil limits the surgical stress response in non-diabetic adult patients and that low-dose glucose loading during anesthesia may attenuate the catabolism of fat [12]
As the highest concentration of glucose in both groups was 156 mg/dl, none of the patients required intravenous insulin. These results suggest that, even in elderly patients, remifentanil-induced anesthesia may prevent hyperglycemia associated with low-dose glucose infusion
Summary
Previous studies showed that remifentanil-induced anesthesia can inhibit surgical stress response in non-diabetic adult patients and that low-dose glucose loading during anesthesia may attenuate fat catabolism. In elderly patients, intraoperative low glucose infusion may attenuate the catabolism of fat without causing harmful hyperglycemia during remifentanil-induced anesthesia. We previously reported that anesthesia using remifentanil limits the surgical stress response in non-diabetic adult patients and that low-dose glucose loading during anesthesia may attenuate the catabolism of fat [12]. Patients are influenced by a decrease in basal metabolism and an increase in insulin resistance These studies suggest that, while low-dose glucose loading during remifentanil-induced anesthesia may decrease stress hormone secretion and fat catabolism without causing hyperglycemia in adults, it may induce hyperglycemia in elderly patients. Little is known about the effect of glucose loading on metabolism in elderly patients during remifentanil-induced anesthesia
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
