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Metabolic perioperative management: novel concepts
Gastrointestinal Disease, Ersta Hospital, Stockholm.ORCID iD: 0000-0003-2636-4745
Gastrointestinal Disease, Ersta Hospital, Stockholm.
Gastrointestinal Disease, Ersta Hospital, Stockholm.
Gastrointestinal Disease, Ersta Hospital, Stockholm.
2005 (English)In: Current Opinion in Critical Care, ISSN 1070-5295, E-ISSN 1531-7072, Vol. 11, no 4, 295-9 p.Article, review/survey (Refereed) Published
Abstract [en]

Purpose of review: This review summarizes novel information regarding the role of metabolic control in the perioperative period.

Recent findings: Managing perioperative metabolism has recently been shown to be an important way to improve outcomes in surgical care. In particular, postoperative insulin resistance and hyperglycemia have been linked to many common complications. Recent studies have explored the toxicity of hyperglycemia and suggest a causal relation between insulin resistance and complications in the postoperative state. Controlling glucose concentrations with insulin has been shown to also improve protein balance and fat metabolism. In addition, insulin may affect other hormones including insulinlike growth factor-I during surgical stress. Lastly, recent data suggest that hyperglycemia plays an important role in aggravating the inflammatory response, in that overflow of substrates in the mitochondria causes the formation of excess free oxygen radicals and may also alter gene expression to enhance cytokine production. Although overcoming insulin resistance by insulin infusion is one way of combating hyperglycemia, prevention of its development can also be achieved by using epidural blockade to reduce the release of adrenal stress hormones and to control pain, by preoperative carbohydrates instead of overnight fasting, and by minimal invasive surgical techniques.

Summary: Minimizing the effects of insulin resistance has been shown to substantially improve outcome after surgical stress.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2005. Vol. 11, no 4, 295-9 p.
Keyword [en]
Complications, hyperglycemia, insulin resistance, metabolism, surgery
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-40373DOI: 10.1097/01.ccx.0000166395.65764.71ISI: 000232199600001PubMedID: 16015105Scopus ID: 2-s2.0-24344501354OAI: oai:DiVA.org:oru-40373DiVA: diva2:777174
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2016-05-27Bibliographically approved

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CiteExportLink to record
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Citation style
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