Integrated analysis of protein and glucose metabolism during surgery: effects of anesthesia

Abstract

The aim of this study was to assess dynamic changes in protein and glucose metabolism during surgery. Twelve patients undergoing colorectal surgery received either intravenous propofol anesthesia ( n = 6) or inhalational anesthesia with desflurane ( n = 6). Pre- and intraoperative protein and glucose kinetics were analyzed by an isotope dilution technique usingl-[1-13C]leucine and [6,6-2H2]glucose. Plasma concentrations of glucose, lactate, free fatty acids, insulin, glucagon, and cortisol were measured before and after 2 h of surgery. The rates of appearance of leucine and glucose, leucine oxidation, protein synthesis, and glucose clearance decreased during surgery, independent of the type of anesthesia ( P < 0.05). A correlation between the rate of appearance of leucine and glucose was observed ( r = 0.755, P < 0.001). Intraoperative plasma cortisol and glucose concentrations increased ( P< 0.05), whereas plasma concentrations of lactate, free fatty acids, insulin, and glucagon did not change. Surgery causes a depression of whole body protein and glucose metabolism, independent of the anesthetic technique. There is a correlation between perioperative glucose production and protein breakdown.