Impact Of Perioperative Intravenous Glucose On Ketone Body Production And Lipid Metabolism During Minimally Invasive Colorectal Surgery

Abstract

Surgical stress and long preoperative starvation facilitate catabolism, insulin resistance, and postoperative hyperglycemia and increase lipolysis and ketogenesis. Even though perioperative carbohydrate interventions are instrumental in the minimization of metabolic derangements, there is scarce evidence on the use of intravenous carbohydrates in minimally invasive surgical procedures. Purpose: The aim of the research was to compare the metabolic responses of intravenous infusion of 150g of glucose during the night before surgery and during the induction of anesthesia among patients undergoing elective laparoscopic colectomy. Methods: The study was a prospective comparative study on 130 adults who were due to undergo elective laparoscopic colectomy with 65 in a glucose group and 65 in a control group. The ketone bodies (total ketone bodies, acetoacetic acid, 3-hydroxybutyric acid), free fatty acids and stress hormones (adrenaline, noradrenaline, dopamine, cortisol) were assessed at induction of anesthesia, 2h following induction and at the conclusion of the surgery; stress hormones were also assessed on the following day. Demographic and perioperative data were captured and compared with each other using the relevant statistical tests. Findings: There were no significant differences in baseline demographic and perioperative demographic. The ketone body levels were subsequently found to be much lower in the glucose group at induction and was still much lower at 2 h post induction and at the terminus of the surgical procedure than was the case with controls, which demonstrated that ketogenesis was attenuated. Induction level of free fatty acids was lower in glucose group and showed a controlled perioperative trend with the values aligning between the groups at the end of the surgical procedure. At no time point were there any significant differences in the concentration of adrenaline and noradrenaline between groups. Dopamine showed considerable increase in the glucose group on the following day after surgery, and cortisol showed considerable decrease at the 2 h after induction in the glucose group, but no difference at the later time points. Conclusion: Ketone body generation and lipid metabolism deregulation in laparoscopic colectomy are suppressed by the use of perioperative intravenous glucose that does not trigger excessive levels of stress hormones, indicating that glucose infusion has a positive metabolic effect on laparoscopic surgery.