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Comparison of two anesthesia techniques on perioperative insulin response to i.v. glucose infusion in children
I Gouyet1, M C Dubois, I Murat
1Department of Pediatric Anesthesia, Hôpital Saint-Vincent de Paul, Paris, France.
Insights
Regional anesthesia in children may enhance insulin secretion post-surgery compared to general anesthesia, potentially improving nitrogen balance. Further research is needed to confirm these findings in pediatric anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Endocrinology
- Metabolic Research
Background:
- Perioperative glucose and insulin regulation is crucial in pediatric patients.
- Anesthesia techniques can influence metabolic responses during surgery.
- Understanding these effects is vital for optimizing patient care.
Purpose of the Study:
- To compare perioperative blood glucose and insulin levels in children undergoing general anesthesia (GA) versus combined general and regional anesthesia (RA).
- To investigate the impact of different anesthesia techniques on glucose-insulin homeostasis in pediatric surgical patients.
Main Methods:
- A randomized study involving 20 children (1-9 years) assigned to GA or RA groups.
- Both groups received identical dextrose infusions.
- Blood samples were collected at multiple time points for glucose and insulin analysis.
Main Results:
- Blood glucose levels increased similarly in both groups post-glucose load.
- Insulin levels showed no significant change in the GA group but increased significantly in the RA group.
- The insulin/blood glucose ratio increased significantly only in the RA group.
Conclusions:
- Regional anesthesia in children may be associated with enhanced insulin secretion compared to general anesthesia.
- This increased insulin response in the RA group could suggest peripheral insulin resistance or a beneficial effect on nitrogen balance.
- Further investigation into the clinical implications of these metabolic changes is warranted.
Abstract:
Perioperative blood glucose and insulin levels were measured in children (1-9 years of age) randomly assigned to two groups according to anesthesia technique, general anesthesia (group GA) or general anesthesia combined with regional anesthesia (group RA). Children in the GA group (n = 10) received halothane and opioids, while children of the RA group received epidural anesthesia with bupivacaine (0.25%) and adrenaline combined with halothane anesthesia (n = 10). Children in both groups received 2.5% dextrose in 0.4 N saline administered by volumetric infusion pumps throughout the study period, the infusion rate being adapted to the child's age. Blood samples for glucose and insulin determinations were obtained: at induction, at the end of surgery, and 30, 60 and 120 min after surgery. In response to an identical glucose load, blood glucose levels increased significantly in both groups (P < 0.001), while no differences between groups were observed. Insulin levels did not change significantly postoperatively in the GA group (P = 0.058), while a significant increase was observed in the RA group (P < 0.001). Insulin/blood glucose ratio increased significantly only in the RA group (P < 0.05). The higher insulin secretion in response to glucose infusion in the RA group compared to the GA group may indicate an increased peripheral insulin resistance after regional anesthesia or, more likely, this secretion may be beneficial in contributing to improve postoperative nitrogen balance.