PLASMA GLUCOSE RESPONSE AS A MONITOR OF SYMPATHETIC ACTIVITY DURING ANESTHESIA AND SURGERY

Abstract

Bl ood glucos e l evels meas ured a t half hour intervals in a series of 45 major s urgica l procedur es demonstrated a consis tent hyp er glycemi a during the course of operation . Peaks were ass ociated with per iods of cardi a-vascular stress .. I n cont r ast , pat ients in whom autonomi c act ivi ty was inhibited by ganglionic blockade demonstra t ed a cons ist ent decrease in blood g lucose .
Pha rmacologic a rmament arium for contr o l of the hyperme tabolic s tate i nduced by surg ical /anesthe t ic s tres s i s r e adily available .
Open hear t patient s r e ceived 2mg/ kg of morph i ne by drip during i nducti on. Ni trous ox i de-oxyge n 60/40 was supplemented with d-tubocurarine or pancuronium as ne c-essary t o ~ a i n t a i n apnea . Ve nt i lation was cont rol l ed to maintain PaCo of 38- 40 Tor r . General s urgical procedure
s were s:;l-'tJ .i..eme nt e d wi.t.h meperidine as i nd i c a t e d. Sodium Nitroprusside or enf lurane were empl oyed b r iefly for control of hypertensive episodes on several occasions .
Surgical f l ui d l osse s were replaced by lact ated Ri ngerls solution, albumin, fresh-frozen plasma and pac ked cells . Pump prime was with p l asmalyte* . Dextrose 5% i n water was used only as a drug- i nf usion veh icle . Five patients of t he general surgery gr oup given pent o l i nium ganglionic blockade , 5-l5mg . as ne cess ar y t o mai nta i n a systol ic B. P. in t he 60-80 Torr range ,provide d a measure o f t he relationship aut onomi c sti mulat i o n e xer t s i n blood gluc ose response to trauma.