[Postaggression metabolism following laparotomy and thoracotomy]

The purpose of this investigation was to collect data concerning changes in carbohydrate and amino acid metabolism following different surgical operations (thoracotomies, laparotomies). Blood of 20 metabolically healthy adult surgical patients, who had to undergo elective surgery (lobectomies, pneumonectomies, colon resections) was examined preoperatively, immediately postoperatively and from 1.-4.postoperative day. The experimental data during the perioperative phase showed a similar pattern in both groups of patients: We found a significant elevation in the blood glucose level and there was also a rise in plasma cortisol and plasma free fatty acids levels. We found no significant changes of blood lactate, plasma insulin and branched chain amino acids. Simultaneously we found a drop in plasma albumin, pre-albumin and some glucoplastic amino acids (ALA, GLN, THR, PRO). It is concluded that major abdominal and thoracic surgery give rise to a nonspecific stress situation reflected in carbohydrate and amino acid metabolism with the following metabolic symptoms: Raised lipolysis and gluconeogenesis, disturbance of glucose utilisation and obvious peripheral insulin resistance. These perioperative metabolic effects show some similarities to the metabolic situation in diabetes mellitus type 2.