Hyperglycemia during hepatic resection: continuous monitoring of blood glucose concentration

• Published in: The American journal of surgery Vol. 199; no. 1; pp. 8 - 13
• Main Authors: Maeda, Hiromichi, M.D, Okabayashi, Takehiro, M.D, Nishimori, Isao, M.D, Yamashita, Koichi, M.D, Sugimoto, Takeki, M.D, Hanazaki, Kazuhiro, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2010; Elsevier; Elsevier Limited
• Subjects: Accuracy; Aged; Aged, 80 and over; Analysis of Variance; Biological and medical sciences; Blood; Blood Glucose - analysis; Blood levels; Blood pressure; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Catheters; Cirrhosis; Continuous blood glucose monitoring; Diabetes; Fasting; Female; Follow-Up Studies; General aspects; Glucose; Glucose metabolism; Glycogen; Hepatectomy - methods; Hepatic resection; Hepatocytes; Humans; Hyperglycemia; Hyperglycemia - etiology; Hyperglycemia - prevention & control; Hypoglycemia; Hypoxia; Insulin; Ischemia; Liver; Liver cirrhosis; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Metabolism; Middle Aged; Monitoring; Monitoring, Intraoperative - methods; Pancreas; Patients; Pringle procedure; Probability; Prospective Studies; Risk Assessment; Rodents; Sensors; Statistics, Nonparametric; STG-22; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgical stress; Transplants & implants; Treatment Outcome; Variance analysis; Surgical stress; Hyperglycemia; Pringle procedure; STG-22; Continuous blood glucose monitoring; Hepatic resection; Methodology; Continuous; Blood; Stress; Hepatectomy; Medicine; Treatment; Surveillance; Continuous Glucose Monitoring System; Surgery; Procedure; Glycemia
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2008.11.046

Abstract Background and aims This study assessed glucose metabolism via continuous intraoperative monitoring of blood glucose in patients undergoing hepatic resection. Methods Thirty patients who underwent hepatic resection were enrolled. During hepatic resection, blood glucose concentration was continuously measured by an artificial pancreas. Results Glucose concentrations followed a similar up-and-down pattern in all patients during the Pringle maneuver series. The concentration decreased marginally during the first clamping of the hepatoduodenal ligament but showed a rapid increase after unclamping. However, this increase declined with the number of Pringle cycles ( P < .01). Patients with liver cirrhosis showed smaller elevations in glucose concentration after the first unclamping compared with patients without liver cirrhosis ( P < .05). Conclusions The present study showed a rapid and profound transition in glucose concentration during hepatic resection. The mechanism underlying the transition of blood glucose concentration may involve glycogen break down within hepatocytes because of hypoxia.