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Biomedical subjects

Thomas Schricker

Publications and source records attributed to Thomas Schricker.

33 records · Page 2Linked to original sources
PubMed2003

Perioperative glucose infusion and the catabolic response to surgery: the effect of epidural block.

Although the nitrogen-sparing properties of epidural block and i.v. glucose on the days after surgical trauma have been well established, their metabolic effects during the acute phase of the stress response remain unclear. Therefore, in this study we investigated the effect of epidural block on glucose and protein kinetics during and immediately after surgery in patients receiving i.v. glucose at 2 mg x kg(-1) x min(-1). Sixteen patients undergoing colorectal surgery received either general anesthesia with epidural block with bupivacaine (EDA; n = 8) or general anesthesia alone (control; n = 8). Glucose and protein kinetics were determined during and 2 h after the operation by stable isotope tracers [6,6-(2)H(2)]glucose and L-[1-(13)C]leucine. Plasma concentrations of glucose, insulin, cortisol, and glucagon were also determined. Epidural block attenuated the perioperative increase in plasma glucose concentration (P < 0.05). The rate of appearance of glucose (R(a) glucose) and endogenous glucose production (EGP) were slower in the EDA group than in control subjects during (R(a) glucose, EDA 13.2 +/- 1.0 versus control 15.3 +/- 1.8 micromol x kg(-1) x min(-1); P < 0.05; EGP, EDA 1.2 +/- 1.2 versus control 3.8 +/- 1.7 micromol x kg(-1) x min(-1); P < 0.05) and after the operation (P > 0.05). Whereas protein breakdown and amino acid oxidation decreased in both groups (P < 0.05), whole-body protein synthesis remained unchanged. Insulin levels increased with both anesthetic techniques (P < 0.05). Intraoperative plasma concentrations of cortisol and glucagon were smaller in the EDA group (P < 0.05). The intraoperative suppression of EGP by exogenous glucose was more pronounced in the presence of epidural block. However, epidural block failed to exert a protein-sparing effect during the acute phase of the stress response in patients receiving i.v. glucose.

Aged↗
PubMed2002

Epidural blockade modifies perioperative glucose production without affecting protein catabolism.

BACKGROUND: Epidural blockade with local anesthetic has been shown to blunt the increase in plasma glucose concentration during and after abdominal surgery. The aim of the study was to test the hypothesis that epidural blockade inhibits this hyperglycemic response by attenuating endogenous glucose production. The authors further examined if the modification of glucose production by epidural blockade has an impact on perioperative protein catabolism. METHODS: Sixteen patients undergoing colorectal surgery received either general anesthesia and epidural blockade with local anesthetic (n = 8) or general anesthesia alone (control, n = 8). Glucose and protein kinetics were assessed by stable isotope tracer technique ([6,6-2H2]glucose, L-[1-13C]leucine) during and 2 h after surgery. Plasma concentrations of glucose, lactate, free fatty acids (FFA), cortisol, glucagon, and insulin were also determined. RESULTS: Epidural blockade blunted the perioperative increase in the plasma concentration of glucose, cortisol, and glucagon when compared with the control group (P < 0.05). Plasma concentrations of lactate, FFA, and insulin did not change. Intra- and postoperative glucose production was lower in patients with epidural blockade than in control subjects (intraoperative, epidural blockade 8.2 +/- 1.9 vs. control 10.7 +/- 1.4 micromol x kg(-1) x min(-1), P < 0.05; postoperative, epidural blockade 8.5 +/- 1.8 vs. control 10.5 +/- 1.2 micromol x kg(-1) x min(-1), P < 0.05), whereas glucose clearance decreased to a comparable extent in both groups (P < 0.05). Protein breakdown (P < 0.05), protein synthesis (P < 0.05), and amino acid oxidation (P > 0.05) decreased with both anesthetic techniques. CONCLUSIONS: Epidural blockade attenuates the hyperglycemic response to surgery through modification of glucose production. The perioperative suppression of protein metabolism was not influenced by epidural blockade.

Anesthesia, Epidural↗
PubMed2002

Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial.

BACKGROUND: Multimodal analgesia programs have been shown to decrease hospital stay, but it not clear which functions are restored after surgery. The objective of this study is to evaluate the impact of epidural anesthesia and analgesia on functional exercise capacity and health-related quality of life. METHODS: Sixty-four patients undergoing elective colonic resection were randomized to either patient-controlled analgesia with morphine or thoracic epidural analgesia with bupivacaine and fentanyl (epidural group). All patients in both groups received similar perioperative care and were offered the same amount of postoperative oral nutrition and assistance with mobilization. Primary outcome was functional exercise capacity as measured by the 6-min walking test, and secondary outcome was health-related quality of life, as measured by the SF-36 health survey. These were assessed before surgery and at 3 and 6 weeks after hospital discharge. Other variables measured in hospital included pain and fatigue visual analogue scale, bowel function, time out of bed, nutritional intake, complication rate, readiness for discharge, and length of hospital stay. RESULTS: Although the 6-min walking test and the SF-36 physical health component decreased in both groups at 3 and 6 weeks after surgery, the patient-controlled analgesia group experienced a significantly greater decrease at both times (P < 0.01). Patients in the epidural group had lower postoperative pain and fatigue scores, which allowed them to mobilize to a greater extent (P < 0.05) and eat more (P < 0.05). Length of hospital stay and incidence of complications were similar in both groups, although patients in the epidural group were ready to be discharged earlier. CONCLUSIONS: The superior quality of pain relief provided by epidural analgesia had a positive impact on out-of-bed mobilization, bowel function, and intake of food, with long-lasting effects on exercise capacity and health-related quality of life.

Adult↗
PubMed2002

The anabolic effect of epidural blockade requires energy and substrate supply.

BACKGROUND: The authors examined the hypothesis that continuous thoracic epidural blockade with local anesthetic and opioid, in contrast to patient-controlled intravenous analgesia with morphine, stimulates postoperative whole body protein synthesis during combined provision of energy (4 mg x kg(-1) x min(-1) glucose) and amino acids (0.02 ml x kg(-1) x min(-1) Travasol 10%, equivalent to approximately 2.9 g x kg(-1) x day(-1)). METHODS: Sixteen patients were randomly assigned to undergo a 6-h stable isotope infusion study (3 h fasted, 3 h feeding) on the second day after colorectal surgery performed with or without perioperative epidural blockade. Protein synthesis, breakdown and oxidation, glucose production, and clearance were measured by L-[1-(13)C]leucine and [6,6-(2)H(2) ]glucose. RESULTS: Epidural blockade did not affect protein and glucose metabolism in the fasted state. Parenteral alimentation decreased endogenous protein breakdown and glucose production to the same extent in both groups. Administration of glucose and amino acids was associated with an increase in whole body protein synthesis that was modified by the type of analgesia, i.e., protein synthesis increased by 13% in the epidural group (from 93.3 +/- 16.6 to 104.5 +/- 11.1 micromol x kg(-1) x h(-1) ) and by 4% in the patient-controlled analgesia group (from 90.0 +/- 27.1 to 92.9 +/- 14.8 micromol x kg(-1) x h(-1);P = 0.054). CONCLUSIONS: Epidural blockade accentuates the stimulating effect of parenteral alimentation on whole body protein synthesis.

Algorithms↗
PubMedDate not supplied

Patient controlled i.v. analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia.

PURPOSE: To examine the hypothesis that pain treatment with patient controlled analgesia (PCA) using iv morphine is a suitable and safe alternative to epidural analgesia in morbidly obese patients undergoing gastric bypass surgery. We retrospectively compared the postoperative periods in all patients undergoing this procedure in our institution between November 1999 and November 2001. METHODS: According to their perioperative pain treatment, patients were assigned to a PCA group (with iv morphine) or an epidural analgesia group, in which patients received either intermittent doses of morphine or continuous infusions of bupivacaine/fentanyl. Study endpoints included quality of pain control, incidence of cardiovascular and respiratory complications, analgesia related side effects, time to ambulation and first flatus, length of hospital stay, and wound infections. RESULTS: Data from 86 patients were analyzed with 40 patients in the PCA group and 46 patients in the epidural group. Groups were similar with respect to age, body mass index, and gender. The type of analgesia did not affect the quality of pain control at rest, the frequency of nausea and pruritus, the time to ambulation and return of gastrointestinal function, and the length of hospital stay. Patients receiving epidural analgesia had a greater risk of wound infection than subjects with PCA (epidural group: 39%, PCA group: 15%, P = 0.01). CONCLUSION: We conclude that in grossly obese patients undergoing gastric bypass surgery PCA with iv morphine is an acceptable strategy for pain management and may confer some advantages when compared to epidural analgesia.

Adult↗
PubMedDate not supplied

Comparison of analgesic methods for total knee arthroplasty: metabolic effect of exogenous glucose.

BACKGROUND AND OBJECTIVES: This study was set up to assess whether postoperative suppression of gluconeogenesis by dextrose infusion would be influenced by continuous peripheral nerve block (CPNB) with local anesthetics, in comparison with epidural and with intravenous analgesia. METHODS: Twenty-seven patients, undergoing elective primary total knee arthroplasty for osteoarthritis, were randomly allocated to one of the three groups of 9 patients each: patient controlled analgesia (PCA) with i.v. morphine, epidural with bupivacaine 0.1% and fentanyl 3mug/ml, or continuous femoral and sciatic blocks with ropivacaine 0.2%. Endogenous glucose production, an index of gluconeogenesis, and glucose clearance, an index of whole body glucose uptake, were assessed on the second postoperative day by measuring [6,6-(2)H(2)]glucose kinetics after an overnight fast (fasted state), and during a 3-h period infusion of dextrose at 4 mg/kg/min (fed state). Visual analog scale (VAS) at rest and at knee flexion, use of morphine, mobilization, nutritional intake, and bowel function were also collected. RESULTS: Endogenous glucose production was totally suppressed by 3 h of dextrose infusion in all 3 groups (P < .001) while glucose clearance was unchanged. Blood glucose and insulin increased (P < .001), while glucagon decreased, with the greatest change in the epidural group (P < .05). VAS at rest and at knee flexion was significantly lower in patients receiving epidural and CPNB compared to i.v. morphine (P < .05). Restoration of bowel function, assessed as return of bowel movements, was faster in the CPNB group (P < .05). CONCLUSION: Excellent analgesia was achieved in the epidural and continuous nerve block groups. Postoperative gluconeogenesis was totally suppressed by dextrose infusion independent of the analgesia technique with no change in glucose utilization.

Aged↗
PubMedDate not supplied

Integrated analysis of glucose, lipid, and urea metabolism in patients with bladder cancer. Impact of tumor stage.

OBJECTIVE: The aim of the study was to characterize the metabolic changes in non-weight-losing patients with cancer of the bladder and to investigate the effect of tumor stage. The kinetics of glucose, glycerol, and urea metabolism were assessed in 22 weight-stable patients with non-metastatic bladder cancer (tumor stage p </= T2, n = 8; tumor stage p > T2, n = 14) and 10 patients with benign uterine myoma (controls). METHODS: The kinetics of glucose, glycerol, and urea metabolism were assessed by [6,6-(2)H(2)]glucose, [1,1,2,3,3-(2)H(5)]glycerol, and [(15)N(2)]urea. Plasma concentrations of glucose, glycerol, urea, lactate, free fatty acids, insulin, glucagon, cortisol, epinephrine, and norepinephrine also were determined. RESULTS: Plasma concentrations of glucose, urea, and insulin were higher in cancer patients than in controls (P < 0.05). Whereas glucose production was similar in both groups, glucose clearance was lower in patients with bladder cancer (P < 0.05). Glycerol turnover rate was comparable between groups. Whole-body urea synthesis rate was higher in the cancer group than in the control group (P < 0.05), but there was no difference in urea synthesis when calculated per kilogram of fat-free body mass. Plasma concentrations of glycerol, lactate, free fatty acids, glucagon, cortisol, epinephrine, and norepinephrine were similar in both groups. There was no difference in any parameter between patients with an early tumor stage (p < T2) and patients with a later tumor stage (p > T2). CONCLUSION: Patients with bladder cancer had a lower rate of glucose clearance than did control subjects. Lipid metabolism was not affected, whereas urea synthesis rate was elevated in cancer patients. However, when expressed per kilogram of fat-free body mass, no difference in protein breakdown could be observed. The tumor stage had no effect on glucose, lipid, or protein metabolism.

Blood Glucose↗
PubMedDate not supplied

Epidural blockade suppresses lipolysis during major abdominal surgery.

BACKGROUND AND OBJECTIVES: The purpose of the study was to investigate the effect of thoracic epidural administration of local anesthetic, i.e., epidural block on perioperative lipolysis. METHODS: Fourteen patients undergoing elective colorectal surgery were randomly assigned to receive either general anesthesia combined with epidural block (EDA, n = 7) or general anesthesia alone (control, n = 7). The rates of glycerol appearance (R(a) glycerol), i.e., lipolysis, were assessed by the stable isotope tracer [1,1,2,3,3-(2)H(5)]glycerol before, during, and 2 hours after the operation. Plasma concentrations of metabolic substrates (glycerol, free fatty acids [FFA], lactate) and hormones (insulin, glucagon, cortisol) were also determined. RESULTS: In the EDA group, R(a) glycerol decreased to lower intra- and postoperative values than in the control group (P <.05). Perioperative plasma concentrations of glycerol, FFA, lactate, and insulin remained unaltered with both anesthetic techniques. Intraoperative plasma glucagon and cortisol concentrations were lower in the EDA group than in the control group (P <.05). CONCLUSIONS: Epidural block suppresses lipolysis during and 2 hours after major abdominal surgery without affecting plasma glycerol or FFA concentrations.

Aged↗
PubMedDate not supplied

Effect of i.v. dextrose administration on glucose metabolism during surgery.

BACKGROUND: The inhibitory influence of exogenous dextrose on glucose production has been shown to be less pronounced during injury and sepsis. This protocol was designed to investigate the effect of i.v. hypocaloric dextrose on glucose metabolism during elective abdominal surgery. METHODS: Fourteen patients with rectal cancer were studied under fasting conditions and toward the end of a 3-hour infusion of dextrose (2 mg.kg-1 per minute) either in absence (control group, n = 7) or presence of colonic surgery (surgery group, n = 7). Endogenous glucose production was determined by using primed continuous infusions of [6,6-2H2]glucose before and during dextrose administration. We also measured the plasma concentrations of glucose, lactate, cortisol, glucagon, and insulin. RESULTS: The administration of dextrose decreased the endogenous glucose production in all patients (p < .05). This decrease was less pronounced during surgery (p < .05). Plasma glucose concentration increased during dextrose infusion in both groups (p < .05), with higher values in the surgery group than in the control group (p < .05). Plasma concentrations of lactate and glucagon remained unaltered. Dextrose infusion increased the plasma insulin concentrations to the same extent in both groups (p < .05). Cortisol plasma levels increased only in the surgery group (p < .05). CONCLUSIONS: Surgical stress blunts the inhibitory effect of i.v. dextrose on endogenous glucose production.

Blood Glucose↗