Factors of importance in the hyperglycaemia induced by upper abdominal surgery

The variation in the hyperglycaemic response, between different individuals, is large in the immediate postoperative period. In the present study, factors of possible importance in the hyperglycaemic response to standardized elective surgery (cholecystectomy) were determined by stepwise multiple linear regression analysis. The statistical analysis comprised 29 variables which included hormones (catecholamines, cortisol, insulin, thyroid hormones), blood-borne energy metabolites (glucose, lactate, free fatty acids (FFA), glycerol, 3-hydroxybutyrate, alanine) as well as anthropometric data and variables related to surgery and anaesthesia. In linear regression analysis, with one independent variable, the glucose concentration correlated significantly with: the duration of surgery, the dose of pancuronium bromide, the dose of fentanyl, the lactate, adrenaline and cortisol concentrations respectively. The variables which, when successively included in stepwise regression, significantly reduced the residual variance for glucose were, in order of introduction; the duration of surgery and the cortisol and adrenaline concentrations respectively. It is concluded that, in standardized surgical trauma the duration of surgery may influence the metabolic response to surgery. Duration of surgery has, thus, to be taken into account when interpreting results from studies where different treatments are compared. Our results confirm that there is a synergistic effect of cortisol and adrenaline in mediating the hyperglycaemic response to surgery.