Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of sevoflurane and propofol anesthesia on the incidence of hyperglycemia in patients with type 2 diabetes undergoing lung surgery

  • Kim, Hyuckgoo (Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine) ;
  • Han, Jisoo (Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine) ;
  • Jung, Sung Mee (Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine) ;
  • Park, Sang-Jin (Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine) ;
  • Kwon, Nyeong Keon (Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine)
  • Received : 2018.03.26
  • Accepted : 2018.05.15
  • Published : 2018.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The type and regimen of anesthesia may affect perioperative hyperglycemia following major surgical stress. This study compared the effects of sevoflurane and propofol on the incidence of hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery. Methods: This retrospective study included 176 patients with type 2 diabetes mellitus who had undergone lung surgery. Blood glucose levels and clinical outcomes from the preoperative period to the first 2 postoperative days (PODs) were retrospectively examined in patients who received sevoflurane (group S, n= 87) and propofol (group P, n=89) for maintenance of general anesthesia. The primary endpoint was the incidence of persistent hyperglycemia (2 consecutive blood glucose levels >180 mg/dL [10.0 mmol/L]) during the perioperative period. The secondary composite endpoint was the incidence of major postoperative complications and 30-day mortality rate after surgery. Results: Blood glucose levels similarly increased from the preoperative period to the second POD in both groups (p=0.857). Although blood glucose levels at 2 hours after surgery were significantly lower in group P than in group S (p=0.022; 95% confidence interval for mean difference, -27.154 to -2.090), there was no difference in the incidence of persistent hyperglycemia during the perioperative period (group S, 70%; group P, 69%; p=0.816). The composite of major postoperative complications and all-cause in-hospital and 30-day mortality rates were also comparable between the two groups. Conclusion: Sevoflurane and propofol were associated with a comparable incidence of perioperative hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.

Keywords

References

  1. Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000;85:109-17. https://doi.org/10.1093/bja/85.1.109
  2. Thorell A, Efendic S, Gutniak M, Häggmark T, Ljungqvist O. Development of postoperative insulin resistance is associated with the magnitude of operation. Eur J Surg 1993;159:593-9.
  3. Kotagal M, Symons RG, Hirsch IB, Umpierrez GE, Dellinger EP, Farrokhi ET, et al. Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg 2015;261:97-103. https://doi.org/10.1097/SLA.0000000000000688
  4. Wu TY, Putaala J, Sharma G, Strbian D, Tatlisumak T, Davis SM, et al. Persistent hyperglycemia is associated with increased mortality after intracerebral hemorrhage. J Am Heart Assoc 2017;6. pii: e005760. https://doi.org/10.1161/JAHA.117.005760
  5. Akhtar S, Barash PG, Inzucchi SE. Scientific principles and clinical implications of perioperative glucose regulation and control. Anesth Analg 2010;110:478-97. https://doi.org/10.1213/ANE.0b013e3181c6be63
  6. Zuurbier CJ, Keijzers PJ, Koeman A, Van Wezel HB, Hollmann MW. Anesthesia's effects on plasma glucose and insulin and cardiac hexokinase at similar hemodynamics and without major surgical stress in fed rats. Anesth Analg 2008;106:135-42. https://doi.org/10.1213/01.ane.0000297299.91527.74
  7. Ewart RB, Rusy BF, Bradford MW. Effects of enflurane on release of insulin by pancreatic islets in vitro. Anesth Analg 1981;60:878-84.
  8. Tanaka T, Nabatame H, Tanifuji Y. Insulin secretion and glucose utilization are impaired under general anesthesia with sevoflurane as well as isoflurane in a concentration-independent manner. J Anesth 2005;19:277-81. https://doi.org/10.1007/s00540-005-0341-1
  9. Wang L, Ko KW, Lucchinetti E, Zhang L, Troxler H, Hersberger M, et al. Metabolic profiling of hearts exposed to sevoflurane and propofol reveals distinct regulation of fatty acid and glucose oxidation: CD36 and pyruvate dehydrogenase as key regulators in anesthetic-induced fuel shift. Anesthesiology 2010;113:541-51.
  10. Tanaka K, Kawano T, Tsutsumi YM, Kinoshita M, Kakuta N, Hirose K, et al. Differential effects of propofol and isoflurane on glucose utilization and insulin secretion. Life Sci 2011;88:96-103. https://doi.org/10.1016/j.lfs.2010.10.032
  11. Kitamura T, Ogawa M, Kawamura G, Sato K, Yamada Y. The effects of sevoflurane and propofol on glucose metabolism under aerobic conditions in fed rats. Anesth Analg 2009;109:1479-85. https://doi.org/10.1213/ANE.0b013e3181b8554a
  12. Li X, Kitamura T, Kawamura G, Mori Y, Sato K, Araki Y, et al. Comparison of mechanisms underlying changes in glucose utilization in fasted rats anesthetized with propofol or sevoflurane: Hyperinsulinemia is exaggerated by propofol with concomitant insulin resistance induced by an acute lipid load. Biosci Trends 2014;8:155-62. https://doi.org/10.5582/bst.2014.01060
  13. Cok OY, Ozkose Z, Pasaoglu H, Yardim S. Glucose response during craniotomy: propofol-remifentanil versus isofluraneremifentanil. Minerva Anestesiol 2011;77:1141-8.
  14. Kitamura T, Kawamura G, Ogawa M, Yamada Y. Comparison of the changes in blood glucose levels during anesthetic management using sevoflurane and propofol. Masui 2009;58:81-4.
  15. Bilotta F, Giovannini F, Caramia R, Rosa G. Glycemia management in neurocritical care patients: a review. J Neurosurg Anesthesiol 2009;21:2-9. https://doi.org/10.1097/ANA.0b013e31818f8a5c
  16. Yasuda Y, Fukushima Y, Kaneki M, Martyn JA. Anesthesia with propofol induces insulin resistance systemically in skeletal and cardiac muscles and liver of rats. Biochem Biophys Res Commun 2013;431:81-5. https://doi.org/10.1016/j.bbrc.2012.12.084
  17. Kim SP, Broussard JL, Kolka CM. Isoflurane and sevoflurane induce severe hepatic insulin resistance in a canine model. PLoS One 2016;11:e0163275. https://doi.org/10.1371/journal.pone.0163275
  18. Saho S, Kadota Y, Sameshima T, Miyao J, Tsurumaru T, Yoshimura N. The effects of sevoflurane anesthesia on insulin secretion and glucose metabolism in pigs. Anesth Analg 1997;84:1359-65. https://doi.org/10.1213/00000539-199706000-00034
  19. Thorell A, Efendic S, Gutniak M, Häggmark T, Ljungqvist O. Insulin resistance after abdominal surgery. Br J Surg 1994;81:59-63. https://doi.org/10.1002/bjs.1800810120
  20. Tonnesen E, Hohndorf K, Lerbjerg G, Christensen NJ, Huttel MS, Andersen K. Immunological and hormonal responses to lung surgery during one-lung ventilation. Eur J Anaesthesiol 1993;10:189-95.
  21. Jeong JS, Oh SW, Koo GH. Comparison of effects of propofol and enflurane on blood glucose level. Korean J Anesthesiol 1998;34:323-8. Korean. https://doi.org/10.4097/kjae.1998.34.2.323
  22. Kumar M, Tripathi M, Malviya D, Malviya PS, Kumar V, Tyagi A. Influence of two anesthetic techniques on blood sugar level in head injury patients: a comparative study. Anesth Essays Res 2016;10:207-11. https://doi.org/10.4103/0259-1162.172335
  23. Behdad S, Mortazavizadeh A, Ayatollahi V, Khadiv Z, Khalilzadeh S. The effects of propofol and isoflurane on blood glucose during abdominal hysterectomy in diabetic patients. Diabetes Metab J 2014;38:311-6. https://doi.org/10.4093/dmj.2014.38.4.311
  24. McConnell YJ, Johnson PM, Porter GA. Surgical site infections following colorectal surgery in patients with diabetes: association with postoperative hyperglycemia. J Gastrointest Surg 2009;13:508-15. https://doi.org/10.1007/s11605-008-0734-1
  25. Mahid SS, Polk HC Jr, Lewis JN, Turina M. Opportunities for improved performance in surgical specialty practice. Ann Surg 2008;247:380-8. https://doi.org/10.1097/SLA.0b013e31815efd7a
  26. Clarke RS. The hyperglycaemic response to different types of surgery and anaesthesia. Br J Anaesth 1970;42:45-53. https://doi.org/10.1093/bja/42.1.45
  27. Frisch A, Chandra P, Smiley D, Peng L, Rizzo M, Gatcliffe C, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care 2010;33:1783-8. https://doi.org/10.2337/dc10-0304
  28. Krinsley JS. Glycemic control, diabetic status, and mortality in a heterogeneous population of critically ill patients before and during the era of intensive glycemic management: six and one-half years experience at a university-affiliated community hospital. Semin Thorac Cardiovasc Surg 2006;18:317-25. https://doi.org/10.1053/j.semtcvs.2006.12.003
  29. Turina M, Fry DE, Polk HC Jr. Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Crit Care Med 2005;33:1624-33. https://doi.org/10.1097/01.CCM.0000170106.61978.D8
  30. Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg 2013;257:8-14. https://doi.org/10.1097/SLA.0b013e31827b6bbc
  31. Yeh CC, Liao CC, Chang YC, Jeng LB, Yang HR, Shih CC, et al. Adverse outcomes after noncardiac surgery in patients with diabetes: a nationwide population-based retrospective cohort study. Diabetes Care 2013;36:3216-21. https://doi.org/10.2337/dc13-0770
  32. Mohan S, Kaoutzanis C, Welch KB, Vandewarker JF, Winter S, Krapohl G, et al. Postoperative hyperglycemia and adverse outcomes in patients undergoing colorectal surgery: results from the Michigan surgical quality collaborative database. Int J Colorectal Dis 2015;30:1515-23. https://doi.org/10.1007/s00384-015-2322-7
  33. Underwood P, Askari R, Hurwitz S, Chamarthi B, Garg R. Preoperative A1C and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures. Diabetes Care 2014;37:611-6. https://doi.org/10.2337/dc13-1929
  34. Aldam P, Levy N, Hall GM. Perioperative management of diabetic patients: new controversies. Br J Anaesth 2014;113:906-9. https://doi.org/10.1093/bja/aeu259

Cited by

  1. Randomized Trial to Compare Plasma Glucose Trends in Patients Undergoing Surgery for Supratentorial Gliomas under Maintenance of Sevoflurane, Desflurane, and Propofol vol.15, pp.3, 2018, https://doi.org/10.4103/ajns.ajns_235_20
  2. Effects of sevoflurane anesthesia and abdominal surgery on the systemic metabolome: a prospective observational study vol.21, pp.1, 2021, https://doi.org/10.1186/s12871-021-01301-0