None listed
Conditions
Brief summary
Surgery induces a form of diabetes, characterized by elevated blood glucose as a result of insulin resistance. A high glucose is a risk for postoperative infections and cardiovascular events. A normalisation of blood glucose improves both morbidity and mortality. This has been demonstrated in critically ill patients and during operation, especially in cardiovascular surgery. Insulin resistance can be modulated for example by the size of surgery, normalisation of glucose and adequate pain management. The changes observed in deprived insulin sensitivity can derive from the liver where glucose is produced or from peripheral tissues where glucose is metabolised. To understand the metabolic changes during operation insulin resistance is measured, and to discriminate the localisation of insulin resistance, a tracer infusion is used in addition to a hyperinsulinemic normoglycemic clamp. In this randomized prospective study patients scheduled for liver resection are treated to near normoglycemia using insulin infusion or standard treatment with intermittent insulin and differences between the groups in insulin resistance are measured.
Interventions
In this randomized prospective study, 20 evaluable patients scheduled for hepatic resection at a university hospital, will be included. The treatment group receives continuous insulin infusion (1 U/ml) to obtain near normoglycemia (n=10)at the start of anesthesia, the control group receive intermittent insulin when needed (B-glu greater than 200 mg/l). The insulin infusion is stopped at the end of the surgery. A pre- and postoperative hyperinsulinemic normoglycemic clamp with isoptope tracer in
In this randomized prospective study, 20 evaluable patients scheduled for hepatic resection at a university hospital, will be included. The treatment group receives continuous insulin infusion (1 U/ml) to obtain near normoglycemia (n=10)at the start of anesthesia, the control group receive intermittent insulin when needed (B-glu greater than 200 mg/l). The insulin infusion is stopped at the end of the surgery. A pre- and postoperative hyperinsulinemic normoglycemic clamp with isoptope tracer infusion will be performed in addition with tissue samples from muscle and liver to evulate postoperative insulin resistance.
Sponsors
Olav Rooyackers
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Subject)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patient scheduled for open hepatectomy, BMI 20-28, informed consent, no contra-indication for epidural analgesia
Exclusion criteria
Preoperative cortison-treatment, diabetes mellitus, severe hepatic or renal failure, contra-indication for pre-operative beverage,
Outcome results
None listed