Abstract
Background: Hyperglycaemia is one of the stress responses to surgery and anaesthesia. Studies reported that volatile anaesthetics mainly sevoflurane impaired glucose use, suggesting a possible contribution to intraoperative hyperglycaemia.
Aim: To establish an effect if any on blood sugar by IV induction agents.
Methods: It is a prospective observational study. We selected 90 patients of either sex, ages between 18-55 yrs, ASA grade I /II undergoing elective minor surgical procedures with expected duration of 10-15 mins. All patients were divided into three groups (n =30 each);Group –A : received propofol 2 mg/kg, Group-B : received ketamine 2 mg/kg, Group – C : received etomidate 0.3 mg/kg. Blood sugar levels were measured before giving induction agents ( at 0 min , taken as baseline ) then at 5 mins,15 mins, 30 mins, 60 mins,90 mins and 120 mins interval. Hemodynamic parameters like heart rate (HR), mean arterial pressure (MAP) were also measured at similar time interval as blood glucose level. The values of each time interval was compared with respect to baseline value within a group by independent sample t-test.
Results: There were no significant differences between groups with respect to age, weight, gender distribution and duration of surgery. There was no significant change in blood glucose level in propofol. Ketamine increased blood sugar level which was statistically significant (p < 0.05) after 30 mins and 60 minutes from its administration but did not produce clinically significant hyperglycemia (> 180 mg/dl) at any of the study interval. Etomidate decreased blood glucose level which was significant ( p < 0.05 ) after 2 hrs but was within the physiological range. Blood sugar level never decreased to < 60mg/dl. Propofol showed significant decrease in HR and MAP after 5 mins of giving induction agent. Ketamine showed significant increase (p < 0.05) in HR at 5 mins and 15 mins after giving induction agent. Etomidate showed no significant changes in HR & MAP.
Conclusion: Intravenous induction agents also result in impaired glucose response, though the changes are within physiological limits. Hyperglycemia occured with ketamine.
Keywords: Blood sugar level, etomidate, hyperglycemia, induction agent, ketamine, propofol.
References
- Oyama T, Takazawa T. Effects of halothane anaesthesia and surgery on human growth hormone and insulin level in plasma. Br J Anaesth 1971;43:573–580
- Diltoer M, Camu F. Glucose homeostasis and insulin secretion during isoflurane anesthesia in humans. Anesthesiology 1988; 68:880–886
- Gandhi GY, Nuttall GA, Abel MD, Mullany C, Schaff HV, Williams BA, Schrader LM, Rizza RA, McMahon MM. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc 2005;80:862–867
- McGirt MJ, Woodworth GF, Brooke BS, Coon AL, Jain S, Buck D, Huang J, Clatterbuck RE, Tamargo RJ, Perler BA. Hyperglycemia independently increases the risk of perioperative stroke, myocardial infarction, and death after carotid endarterectomy. Neurosurgery 2006;58:1066–1073
- Traynor , C . and G.M. Hall,. Endocrine and metabolic changes during surgery ; Anaesthetic applications. Br . J. Anaesth 1981, 53 : 153 -160.PMID : 7008816.
- Halter JB, Pflug AE. Relationship of impaired insulin secretion during surgical stress to anaesthesia and catecholamine release. Journal of Clinical Endocrinology and Metabolism .1980; 15: 1093 – 98.
- Kitamura T, Sato K, Kawamura G, Yamada Y. The involvement of adenosine triphosphate-sensitive potassium channels in the different effects of sevoflurane and propofol on glucose metabolism in fed rats.Anaesth Analg.2012;114:110-16.
- Sato K, Kitamura T, Kawamkura G, Mori Y, Sato R, Araki Y, Yamada Y.Glucose use in fasted rats under sevoflurane anaesthesia and propofol anaesthesia. Anasth Analg.2013;117:627-33.
- Roden M, Price TB, Perseghin G, Petersen KF, Rothman DL, Cline GW, Schulman GI. Mechanism of free fatty acid-induced insulin resistance in humans. J Clin Invest.1996;97:2859-65.
- Xiang Li, Takayuki Ktamura, Gaku Kawamural, Yoshiteru Moril, Kanako Sato, Yuko Arakil, Rui Satol, Yoshitsugu Yamadal. Comparison of mechanism underlying changes in glucose utilization in fasted rats anasthetised with propofol or sevoflurane: Hyperinsulinemia is exaggerated by an acute lipid load.Bioscience Trends.2014;8(3):155-62.
- Takayuki Kitamura, MD , Makoto Ogawa, MD , Gaku Kawamura, MD , Kanako Sato, MD ,Yoshitsugu Yamada, MD, PhD. The Effects of Sevoflurane and Propofol on Glucose Metabolism Under Aerobic Conditions in Fed Rats (Anesth Analg 2009;109:1479 –85) .
- Cok O. Y.1, Ozkose Z. 2, Pasaoglu H. 3, Yardim S. Glucose response during craniotomy: propofol-remifentanil versus isoflurane-remifentanil . Minerva Anestesiologica 2011 December; 77(12):1141-8
- Saho S, Kadota Y, Sameshima T, Miyao J, Tsurumaru T, Yoshimura N. The effects of sevoflurane anesthesia in insulin secretion and glucose metabolism in pigs. Anesth Analg 1997;84:1359–65
- Kaniaris P , D Lekakis , M. Kykoniatis , E. Kastanas.Serum free fatty acid and blood sugar levels in children under halothane, thiopentone and ketamine anaesthesia. Can.Anasth.Soc.J.1975;22:509-18.
- Saha JK,Xia J,Grondin JM,Engle SK,Jakubowski JA.Acute hyperglycemia induced by ketamine/xylazine anaesthesia in rats:mechanism and implication for preclinical models.Exp Biol Med (Maywood).2005 Nov;230(10):777-84
- Reyes Toso CF, Linares LM, Rodríguez RR. Blood sugar concentrations during ketamine or pentobarbitone anesthesia in rats with or without alpha and beta adrenergic blockade. Departamento de Fisiología, Universidad de Buenos Aires, Argentina.
- Suleiman I . Sharif , Hanan A . Abouazra. Effect of intravenous ketamine administration on blood glucose levels in conscious rabbits.American Journal of pharmacology & Toxicology 4 (2):38-45,2009
- S.Clanachan, J.C Macgrath.Effects of ketamine on the peripheral autonomic nervous system of the rat. Br.J.Pharmacol.1976;58:247-52
- Cevdet SUMER, Omer Lutfi ERHAN, Ayşe Belin OZER, Fuat YILDIZ. Eff ects of etomidate on blood cortisol, insulin, and glucose levels and PONV rates in smokers. Turk J Med Sci 2012; 42 (5): 810-815
- Absolom A, Pledger D, Kong A. Adrenocortical function in critically ill patients 24 hr after a single dose of etomidate. Anaesthesia 1999;54:8617.
- Wagner RL, White PF.Etomidate inhibits adrenocortical function in surgical patients. Anaesthesiology 1984;61:647-651.
- Larsen R, Rathgeber J, Bagdahn A, et al: Effects of propofol on cardiovascular dynamics and coronary blood flow in geriatric patients: A comparison with etomidate. 2. Anaesthesia 1988; 43(Suppl): 25-31
- Coates D, Prys-Roberts C, Spelina K: Propofol (Diprivan) by intravenous infusion with nitrous oxide: Dose requirements and hemodynamic effects. Postgrad Med J 1985; 61:76.
- Van Aken H, Meinshausen E, Prien T, et al: The influence of fentanyl and tracheal intubation on the hemodynamic effects of anesthesia induction with propofol/N2O in humans. Anesthesiology 1988; 68:157-163.
- Salt PJ, Barnes PK, Beswick FJ: Inhibition of neuronal and extraneuronal uptake of noradrenaline by ketamine in the isolated perfused rat heart. Br J Anaesth 1979; 51:835-838.
- Endou M, Hattori Y, Nakaya H, et al: Electrophysiologic mechanisms responsible for inotropic responses to ketamine in guinea pig and rat myocardium. Anesthesiology 1992; 76:409-418.
- Gooding JM, Weng JT, Smith RA, et al: Cardiovascular and pulmonary responses following etomidate induction of anesthesia in patients with demonstrated cardiac disease. Anesth Analg 1979; 58:40-41.
- Criado A, Maseda J, Navarro E, et al: Induction of anaesthesia with etomidate: Haemodynamic study of 36 patients. Br J Anaesth 1980; 52:803-806.
Corresponding Author
Indraprava Mandal
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile: 9438287564
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.151
