Understanding the Mechanisms by Which Isoflurane Modifies the Hyperglycemic Response to Surgery

Lattermann, Ralph; Schricker, Thomas; Wachter, Ulrich; Georgieff, Michael; Goertz, A.

doi:10.1097/00000539-200107000-00026

Cited by 70 publications

(40 citation statements)

References 17 publications

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“…In contrast, epidural anesthesia may block hepatic glucose production and blunt surgery-associated hyperglycemia. Fentanyl and midazolam have no effect on gluconeogenesis but do seem to impair glucose utilization and in that way contribute to intraoperative hyperglycemia (25).…”

Section: Discussionmentioning

confidence: 99%

Effects of acute hyperinsulinemia on insulin signal transduction and glucose transporters in ovine fetal skeletal muscle

Anderson

Thamotharan²,

Kao³

et al. 2005

American Journal of Physiology-Regulatory, Integrative and Comp

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. Effects of acute hyperinsulinemia on insulin signal transduction and glucose transporters in ovine fetal skeletal muscle. Am J Physiol Regul Integr Comp Physiol 288: R473-R481, 2005. First published November 11, 2004; doi:10.1152/ajpregu.00405.2004.-To test the effects of acute fetal hyperinsulinemia on the pattern and time course of insulin signaling in ovine fetal skeletal muscle, we measured selected signal transduction proteins in the mitogenic, protein synthetic, and metabolic pathways in the skeletal muscle of normally growing fetal sheep in utero. In experiment 1, 4-h hyperinsulinemiceuglycemic clamps were conducted in anesthetized twin fetuses to produce selective fetal hyperinsulinemia-euglycemia in one twin and euinsulinemia-euglycemia in the other. Serial skeletal muscle biopsies were taken from each fetus during the clamp and assayed by Western blot for selected insulin signal transduction proteins. Tyrosine phosphorylation of the insulin receptor, insulin receptor substrate-1, and the p85 subunit of phosphatidylinositol 3-kinase doubled at 30 min and gradually returned to control values by 240 min. Phosphorylation of extracellular signal-regulated kinase 1,2 was increased fivefold through 120 min of insulin infusion and decreased to control concentration by 240 min. Protein kinase B phosphorylation doubled at 30 min and remained elevated throughout the study. Phosphorylation of p70 S6K increased fourfold at 30, 60, and 120 min. In the second experiment, a separate group of nonanesthetized singleton fetuses was clamped to intermediate and high hyperinsulinemic-euglycemic conditions for 1 h. GLUT4 increased fourfold in the plasma membrane at 1 h, and hindlimb glucose uptake increased significantly at the higher insulin concentration. These data demonstrate that an acute increase in fetal plasma insulin concentration stimulates a unique pattern of insulin signal transduction proteins in intact skeletal muscle, thereby increasing pathways for mRNA translation, glucose transport, and cell growth. insulin signaling; fetal growth; glucose transporter 4 IN ADULT ANIMALS and humans, insulin has primarily a metabolic role to regulate skeletal muscle glucose uptake with less effect on skeletal muscle protein synthesis than in rapidly growing tissues. Although increased serum insulin concentration in the fetal sheep has been shown to increase fetal skeletal muscle glucose uptake, especially at pharmacological doses (17,18,20,21), insulin in the rapidly growing fetus seems to act largely as an anabolic hormone, promoting skeletal muscle protein synthesis and growth. In human fetuses, abnormal insulin concentrations contribute to variations in fetal growth; excessive insulin promotes fetal overgrowth, whereas insufficient insulin leads to fetal growth restriction. Animal studies have produced experimental deficiencies in insulin secretion in fetal lambs, resulting in fetal growth restriction and limited carcass protein accretion (27). Also, it has been shown in the neonatal pig that insulin action to promote s...

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Section: Discussionmentioning

confidence: 99%

Effects of acute hyperinsulinemia on insulin signal transduction and glucose transporters in ovine fetal skeletal muscle

Anderson

Thamotharan²,

Kao³

et al. 2005

American Journal of Physiology-Regulatory, Integrative and Comp

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“…A hyperglycemic response has been observed in several studies using isoflurane (Lattermann et al, 2001;Saha et al, 2005)) potentially due to impaired glucose clearance and increased glucose production. It is important to stress that although there was a significant difference in blood glucose level between the two groups, all animals remained normoglycemic; therefore an effect of glucose on infarct size or outcome is unlikely.…”

Section: Discussionmentioning

confidence: 99%

Alpha-chloralose is a suitable anesthetic for chronic focal cerebral ischemia studies in the rat: A comparative study

2008

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Abstractα-chloralose is widely used as an anesthetic in studies of the cerebrovasculature because it provides robust metabolic and hemodynamic responses to functional stimulation. However, there have been no controlled studies of focal ischemia in the rat under α-chloralose anesthesia. Artificially ventilated rats were prepared using 1.2−1.5 % isoflurane anesthesia for filament occlusion of the right middle cerebral artery (MCA), and anesthesia was either switched to α-chloralose (60 mg/kg bolus, 30 mg/ kg/hr; n=10) or was maintained on 1% isoflurane (n=10). Following temporary MCA occlusion EEG was monitored from a screw electrode and changes in cerebral blood flow (rCBF) measured with a laser Doppler probe placed over the ischemic cortex. This study shows that α-chloralose is a safe anesthetic for ischemia studies and provides excellent survival. Compared with isoflurane, the cortical and total infarct volumes are larger in the α-chloralose anesthetized animals, while the functional outcome at 72 hours is similar. The total duration of peri-infarct flow transients (PIFTs) is also significantly longer in α-chloralose anesthetized animals. The average amplitude of the flow transients showed a good correlation with the extent of edema in all animals as did the total duration of non-convulsive seizures (NCS) in the α-chloralose anesthetized animals.

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“…Also, desaturation and arterial hypoxemia, increase a sympathetic autonomous response that favors glucagon release by an alpha-receptor action (20 (21). The hyperglycemic response during inhaled anesthesia with isoflurane is a consequence of both impaired glucose clearance and increased glucose production (22,23).…”

Section: Predisposing Factorsmentioning

confidence: 99%

Glycemic Control in Cardiac Surgery

Rosas¹,

Goicoechea-Turcott²,

Ortíz³

et al. 2012

Perioperative Considerations in Cardiac Surgery

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Understanding the Mechanisms by Which Isoflurane Modifies the Hyperglycemic Response to Surgery

Cited by 70 publications

References 17 publications

Effects of acute hyperinsulinemia on insulin signal transduction and glucose transporters in ovine fetal skeletal muscle

Effects of acute hyperinsulinemia on insulin signal transduction and glucose transporters in ovine fetal skeletal muscle

Alpha-chloralose is a suitable anesthetic for chronic focal cerebral ischemia studies in the rat: A comparative study

Glycemic Control in Cardiac Surgery

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