Effect of Laparoscopic Colon Resection on Postoperative Glucose Utilization and Protein Sparing

Carli, Franco; Galeone, Marina; Gzodzic, Branca; Hong, Xi; Fried, Gerald M.; Wykes, Linda; Eberhart, Leopold; Schricker, Thomas

doi:10.1001/archsurg.140.6.593

Cited by 19 publications

(4 citation statements)

References 13 publications

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“…In addition, laparoscopy attenuates the neurohormonal, metabolic, and immunologic stress responses [2,3], reducing the incidence of postoperative wound infection and pneumonia [4].…”

mentioning

confidence: 99%

Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program

et al. 2007

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“…In addition, laparoscopy attenuates the neurohormonal, metabolic, and immunologic stress responses [2,3], reducing the incidence of postoperative wound infection and pneumonia [4].…”

mentioning

confidence: 99%

Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program

et al. 2007

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“…These elements include moderation of inflammatory and metabolic responses, decreased pain, improved pulmonary function, and a decreased rate of wound infection. [2][3][4] One might assume that earlier recovery of bowel function and hospital discharge following laparoscopic surgery may be associated with less extensive tissue damage. However, a recent study comparing a conventional with a fasttrack accelerated perioperative program in patients undergoing laparoscopic colectomy suggests this not the case.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] This technique has gained popularity following publication of large randomized studies which compared the safety and efficacy of laparoscopic-assisted resection of colorectal malignancy with colectomy done by a laparotomy. [5][6][7] Although many studies comparing these two surgical approaches to colectomy have reported beneficial effects of laparoscopy on restoration of bowel function, few studies have standardized the postoperative analgesia regimen, and perioperative surgical and nursing care.…”

Section: Objectif : Un Plan De Soins Normalisé Comportant L'analgésiementioning

confidence: 99%

Laparoscopy for colectomy accelerates restoration of bowel function when using patient controlled analgesia

Hong

Mistraletti

Zandi

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: A standardized care plan incorporating patient-controlled analgesia with iv morphine and a non-accelerated feeding schedule following colectomy was used to compare return of bowel function and hospital discharge times following surgery done by laparoscopy or laparotomy. Methods:Thirty-eight patients were assigned to undergo either laparoscopic or laparotomy colon resection. Postoperative analgesia was achieved with patient-controlled analgesia with iv morphine. General anesthesia and perioperative care were standardized, and a traditional surgical and nursing care program was implemented. Gastrointestinal function (time from surgery to return of passage of flatus and presence of bowel movements), pain intensity (visual analogue scale) at rest, on coughing and on mobilization, amount of morphine used, and criteria for discharge and length of hospital stay were recorded.Results: Bowel movements resumed earlier in the laparoscopic group (P < 0.05), but not passage of flatus. No significant relationship was found between the amount of morphine used and return of bowel function. Cumulative morphine consumption during the first two postoperative days was similar in both groups. Where a trend towards lower postoperative visual analogue scale scores was observed in the laparoscopic group, visual analogue scale scores on coughing were lower in the laparoscopic vs laparotomy group only during the first 24 hr (P < 0.05). Length of hospital stay was significantly shorter in the laparoscopic group (P < 0.05), although times to meet discharge criteria were similar in both groups. Conclusions:When patient-controlled analgesia with morphine and a traditional perioperative program are used, a laparoscopic approach to colon surgery promotes earlier restoration of bowel function and more rapid hospital discharge in comparison to resection by laparotomy. Objectif : Un plan de soins normalisé comportant l'analgésie autocontrôlée avec de la morphine iv et un programme d'alimentation

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“…The effects of volatile anesthetics on basal insulin secretion and hepatic insulin extraction, an indicator of insulin resistance, are unknown. Beyond glucose and insulin homeostasis, only a few studies have attempted to examine the natural perioperative course of protein or lipid metabolism (Carli et al, 2005; Schricker et al, 2001). These studies demonstrated that pathways beyond glucose homeostasis are likely critical components of perioperative metabolism, but were limited by available analytic techniques and complex stable isotope labeling methods.…”

Section: Introductionmentioning

confidence: 99%

The neuroendocrine stress response compensates for suppression of insulin secretion by volatile anesthetic agents: An observational study

Tharp

Breidenstein

Friend

et al. 2023

Physiological Reports

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Alterations in perioperative metabolic function, particularly hyperglycemia, are associated with increased post‐operative complications, even in patients without preexisting metabolic abnormalities. Anesthetic medications and the neuroendocrine stress response to surgery may both contribute to altered energy metabolism through impaired glucose and insulin homeostasis but the discrete pathways involved are unclear. Prior human studies, though informative, have been limited by analytic sensitivity or technique, preventing resolution of underlying mechanisms. We hypothesized that general anesthesia with a volatile agent would suppress basal insulin secretion without altering hepatic insulin extraction, and that surgical stress would promote hyperglycemia through gluconeogenesis, lipid oxidation, and insulin resistance. In order to address these hypotheses, we conducted an observational study of subjects undergoing multi‐level lumbar surgery with an inhaled anesthetic agent. We measured circulating glucose, insulin, c‐peptide, and cortisol frequently throughout the perioperative period and analyzed the circulating metabolome in a subset of these samples. We found volatile anesthetic agents suppress basal insulin secretion and uncouple glucose‐stimulated insulin secretion. Following surgical stimulus, this inhibition disappeared and there was gluconeogenesis with selective amino acid metabolism. No robust evidence of lipid metabolism or insulin resistance was observed. These results show that volatile anesthetic agents suppress basal insulin secretion, which results in reduced glucose metabolism. The neuroendocrine stress response to surgery ameliorates the inhibitory effect of the volatile agent on insulin secretion and glucose metabolism, promoting catabolic gluconeogenesis. A better understanding of the complex metabolic interaction between anesthetic medications and surgical stress is needed to inform design of clinical pathways aimed at improving perioperative metabolic function.

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Effect of Laparoscopic Colon Resection on Postoperative Glucose Utilization and Protein Sparing

Cited by 19 publications

References 13 publications

Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program

Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program

Laparoscopy for colectomy accelerates restoration of bowel function when using patient controlled analgesia

The neuroendocrine stress response compensates for suppression of insulin secretion by volatile anesthetic agents: An observational study

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