Blood glucose levels were studied prospectively in 40 patients undergoing elective major craniotomy. A significant (p < 0.01) hyperglycaemic response was noted after scalp infiltration with adrenaline and incision (0.5 mmol/l) and with continued surgery (0.9 mmol/l). Patients aged 50 years and under showed a significantly greater rise with adrenaline and incision than older patients (0.8 compared with 0.4 mmol/l p < 0.01). Preoperative high dose steroid therapy did not modify the response Blood glucose changes were unrelated to sex, obesity, a family history of diabetes, the duration of starvation, intraoperative body temperature, anaesthetic technique induced hypotension or blood loss.
References
1.
AllisonS. P., TomlinP. J., and ChamberlainM. J. (1969): “Some effects of anaesthesia and surgery on carbohydrate and fat metabolism”, Brit. J. Anaesth., 41, 588.
2.
AtkinsonR. S., RushmanG. B., and LeeJ. A. (1976): A Synopsis of Anaesthesia, 8th edn., p. 361. John Wright, Bristol.
3.
BiebuyckJ. F. (1973): “Anaesthesia and hepatic metabolism: current concepts of carbohydrate haemostasis”, Anesthesiology, 39, 188.
4.
BlohmeG. (1974): “Intravenous glucose tolerance and early insulin response”, Acta Med. Scand. Suppl., 566, 104.
5.
BloomS. R. (1975): “Glucagon”, Brit. J. Hosp. Med., 13, 150.
6.
BolandE. W. (1958): “Clinical observations with 16a-methyl cortisone compounds. Preliminary therapeutic trials with dexamethasone (16a-methyl 9a-fluoroprednisolone) in patients with rheumatoid arthritis”, Ann. Rheum. Dis., 17, 376.
7.
BoyerM. H. (1967): “Hyperosmolar anacidotic coma in association with glucocorticoid therapy”, J. Amer. Med. Ass., 202, 1007.
8.
BunimJ. J., BlackR. L., LutwakL., PetersonR. E., and WhedonG. D. (1958): “Studies on dexamethasone, a new synthetic steroid in rheumatoid arthritis — a preliminary report”, Arth. and Rheum., 1, 313.
9.
CervenkoF. W., and GreeneN. M. (1967): “Effect of cyclopropane anaesthesia on glucose assimilation coefficient of man”, Anesthesiology, 28, 914.
10.
ClarkeR. S. J. (1970): “The hyperglycaemic response to different types of surgery and anaesthesia”, Brit. J. Anaesth., 42, 45.
11.
CorcoranF. H., GranatirR. F., and SchlangH. A. (1971): “Hyperglycaemic hyperosmolar nonketotic coma associated with corticosteroid therapy”, J. Fla. Med. Ass., 58, 38.
12.
FrenchL. A. (1966): “The use of steroids in the treatment of cerebral oedema”, Bull. N.Y. Acad. Med., 42, 301.
13.
HunterA. R. (1959): “Halothane and the blood sugar”, Brit. J. Anaesth., 31, 490.
14.
JohnstonI. D. A. (1973): “The metabolic and endocrine response to injury: a review”, Brit. J. Anaesth., 45, 252.
15.
KeatingV. (1958): “Carbohydrate metabolism. The effects of surgery in a tropical population”, Anaesthesia, 13, 434.
16.
MehtaS. (1972): “The influence of anaesthesia with thiopentone and diazepam on the blood sugar level during surgery”, Brit. J. Anaesth., 44, 75.
17.
MerinR. G. (1970): “The relationship between myocardial infarction and glucose metabolism in the halothane depressed heart: I The effect of hyperglycaemia”, Anesthesiology, 33, 391.
18.
OyamaT. (1973): “Endocrine responses to anaesthetic agents”, Brit. J. Anaesth., 45, 276.
19.
StoberH. B., and HeathD. F. (1973): “The effects of trauma on carbohydrate metabolism”, Brit. J. Anaesth., 45, 244.
20.
WatsonB. G. (1972): “Blood glucose levels in children during surgery”, Brit. J. Anaesth., 44, 712.
