The Effects of Propofol and Isoflurane on Blood Glucose during Abdominal Hysterectomy in Diabetic Patients

Abstract

BackgroundAcute hyperglycemia in the perioperative period is associated with significantly increased complications. In few human studies the effects of propofol and inhalational anesthetic on the glucose metabolism were compared. In this study we evaluated the effect of propofol and isoflurane on blood glucose during abdominal hysterectomy in diabetic patients.MethodsAfter approval by the Ethical Committee and written informed consent, thirty 35 to 65 years old diabetic women underwent for elective abdominal hysterectomy under general anesthesia were studied in this randomized single blind clinical trial study. The plasma glucose was maintained at 100 to 180 mg/dL during the operation. Anesthesia protocol was similar in two groups except maintenance of anesthesia that was with infusion of propofol in the propofol group and with isoflurane in the isoflurane group. Blood glucose level and the rate of insulin intake during surgery compared between two groups.ResultsMean blood glucose before induction of anesthesia did not have significant difference between two groups, but 60 and 90 minutes after starting the operation blood glucose in the propofol group was significantly lower than isoflurane group. Also with using Repeated Measure test, two groups was significantly different according to blood glucose (P=0.045). Mean of administration of insulin during the surgery did not have significant difference between two groups by using repeated measure test and P=0.271. Also mean of bispectral index in different times during the surgery between two groups didn't have significant difference (P=0.35 repeated measure test).ConclusionBlood glucose increased during maintenance of anesthesia with isoflurane compared to propofol during the surgery.

Isoflurane and Sevoflurane Induce Severe Hepatic Insulin Resistance in a Canine Model

“…We show that anesthesia itself can alter glucose metabolism in liver and peripheral tissues in both lean and insulin resistant states. Supporting this finding, there have been documented instances of hyperglycemia under anesthesia in diabetic [23] and lean patients [24]; this latter study also demonstrated a reduction in the rate of glucose appearance and clearance under anesthesia in humans. Thus, our results are highly relevant to humans, such that anesthesia alters both glucose metabolism and insulin sensitivity even in healthy lean individuals.…”

Biomimetic electrospun coatings increase the in vivo sensitivity of implantable glucose biosensors

“…). Similar results are widely reported . In a similar study, Koschwanez et al tested the effect of isoflurane and pentobarbitone on blood glucose levels, and used pentobarbitone since it did not cause hyperglycemia for sensor functional efficacy testing .…”

“…Similar results are widely reported. 14,[30][31][32][33] In a similar study, Koschwanez et al tested the effect of isoflurane and pentobarbitone on blood glucose levels, and used pentobarbitone since it did not cause hyperglycemia for sensor functional efficacy testing. 14 They administered a single IP dose of 0.3 mL of 50 mg/mL pentobarbitone (Nembutal Sodium Solution).…”

Sevoflurane Impairs Insulin Secretion and Tissue‐Specific Glucose Uptake In Vivo

“…The combination of impaired insulin action on skeletal muscle and reduced insulin levels can be harmful, especially if the condition is not detected in due time. In patients with diabetes, intravenous propofol anaesthesia prevents increases in blood glucose levels during surgery in comparison with isoflurane anaesthesia . This could suggest that propofol is superior to general anaesthesia in patients with diabetics.…”