Shoko Kitamura, Jun Hirokawa, Saori Sako and Takeshi Yokoyama
Background and aim: Glucose is stored mainly in the liver and muscles as glycogen. However, the total calories are less than basal energy expenditure for one day. Overnight fast before surgery may be stressful for patients. Therefore, we investigated the effect of glucose administration on the metabolic state during anesthesia. Methods: After getting written informed consent, patients undergoing maxillofacial surgery were randomly assigned to two groups throughout the surgical procedure, G group receiving acetated Ringer solution with 1.5% glucose (n=12) and R group receiving acetated Ringer solution without glucose (n=11). Anesthesia was maintained with remifentanil and sevoflurane. Blood glucose level was monitored continuously using the STG-22TM from after the induction of anesthesia. Plasma ketone bodies were evaluated before and after surgery. Respiratory quotient (RQ) was monitored continuously during anesthesia using the indirect calorimetry V-Max. Results: In G group (n=12), patients received 0.17 ± 0.03 g/kg/hr of glucose. But hyperglycemia did not observed during surgery. The mean blood glucose levels were maintained stably <150 mg/dL during surgery. The plasma concentration of ketone bodies was significantly higher at T4 in R group than in G group (p=0.027). However, it decreased from T1 to T3, T4 in G group. RQ decreased significantly from 0.93 ± 0.14 to 0.78 ± 0.11 in the R group (p=0.037), while it was kept at 0.88 ± 0.09 in the G group. There is no significant difference between group R and group G in REE during operation. Conclusion: Intraoperative 0.17 ± 0.03 g/kg/hr of glucose administration may suppress ketogenesis and can maintain glucose metabolism successfully without causing hyperglycemia.