Randomized trial to compare plasma glucose trends in patients undergoing surgery for supratentorial gliomas under maintenance of sevoflurane, desflurane, and propofol

Background: Anesthetic agents influence the glycemic response by affecting the neuroendocrine surgical response or directly modifying pancreatic insulin release. Due to chances of neuronal damage, intraoperative hyperglycemia and hypoglycemia both are detrimental for patients undergoing neurosurgeries. Inhalational (sevoflurane and desflurane) and intravenous (propofol) agents have been found to raise intraoperative glucose levels in nonneurological surgeries. Aim: We aimed to compare the intraoperative glucose levels in supratentorial glioma surgeries under the maintenance of three anesthetic agents such as sevoflurane, desflurane, and propofol. Materials and Methods: This randomized trial was conducted with 90 nondiabetic adults with supratentorial glioma. Thirty patients were allocated randomly to the three groups receiving sevoflurane, desflurane, and propofol. Baseline and hourly plasma glucose levels were recorded. Postoperatively, the time required to achieve an Aldrete score of 9 and complications were assessed. Results: Baseline plasma glucose levels were 111.23 ± 11.67, 109.47 ± 19.75, and 111.7 ± 13.88 mg/dL (P = 0.84) in sevoflurance, desflurane, and propofol group, respectively. All of them showed an elevation of plasma glucose in relation to the time of surgery with variable trends. In the 4^th and 5^th h, the elevations in the inhalational groups (sevoflurane and desflurane) were significantly higher than the propofol group (P = 0.003 and 0.002, respectively). The time for achieving Aldrete's score of 9 was higher in the propofol group (P < 0.0001). No differences were observed in the duration of hospital stay or complications. Conclusions: Maintenance of anesthesia in nondiabetic patients showed clinically modest rise of plasma glucose which is higher in patients under sevoflurane and desflurane than under propofol. However, the immediate recovery was faster with inhalational agents compared to propofol-based anesthesia.

Key-words:

Blood glucose - desflurane - glioma - hyperglycemia - neurosurgical procedures - plasma glucose propofol - propofol

Financial support and sponsorship

Nil.

Publikationsverlauf

Eingereicht: 16. Mai 2020

Angenommen: 29. Juni 2020

Artikel online veröffentlicht:
16. August 2022

• References

• 1 Diltoer M, Camu F. Glucose homeostasis and insulin secretion during isoflurane anesthesia in humans. Anesthesiology 1988;68:880-6.
• 2 Nishiyama T, Yamashita K, Yokoyama T. Stress hormone changes in general anesthesia of long duration: Isoflurane-nitrous oxide vs sevoflurane-nitrous oxide anesthesia. J Clin Anesth 2005;17:586-91.
• 3 Tanaka K, Kawano T, Tsutsumi YM, Kinoshita M, Kakuta N, Hirose K, et al. Differential effects of propofol and isoflurane on glucose utilization and insulin secretion. Life Sci 2011;88:96-103.
• 4 Kitamura T, Ogawa M, Kawamura G, Sato K, Yamada Y. The effects of sevoflurane and propofol on glucose metabolism under aerobic conditions in fed rats. Anesth Analg 2009;109:1479-85.
• 5 Li X, Kitamura T, Kawamura G, Mori Y, Sato K, Araki Y, et al. Comparison of mechanisms underlying changes in glucose utilization in fasted rats anesthetized with propofol or sevoflurane: Hyperinsulinemia is exaggerated by propofol with concomitant insulin resistance induced by an acute lipid load. Biosci Trends 2014;8:155-62.
• 6 Cok OY, Ozkose Z, Pasaoglu H, Yardim S. Glucose response during craniotomy: Propofol-remifentanil versus isoflurane-remifentanil. Minerva Anestesiol 2011;77:1141-8.
• 7 Kitamura T, Kawamura G, Ogawa M, Yamada Y. Comparison of the changes in blood glucose levels during anesthetic management using sevoflurane and propofol. Masui 2009;58:81-4.
• 8 Kumar M, Tripathi M, Malviya D, Malviya PS, Kumar V, Tyagi A. Influence of two anesthetic techniques on blood sugar level in head injury patients: A comparative study. Anesth Essays Res 2016;10:207-11.
• 9 Baldini G, Bagry H, Carli F. Depth of anesthesia with desflurane does not influence the endocrine-metabolic response to pelvic surgery. Acta Anaesthesiol Scand 2008;52:99-105.
• 10 Oyama T, Murakawa T, Matsuki A. Endocrine evaluation of sevoflurane, a new inhalational anesthetic agent. Acta Anaesthesiol Belg 1989;40:269-74.
• 11 Yasuda Y, Fukushima Y, Kaneki M, Martyn JA. Anesthesia with propofol induces insulin resistance systemically in skeletal and cardiac muscles and liver of rats. Biochem Biophys Res Commun 2013;431:81-5.
• 12 Kim SP, Broussard JL, Kolka CM. Isoflurane and sevoflurane induce severe hepatic insulin resistance in a canine model. PLoS One 2016;11:e0163275.
• 13 Saho S, Kadota Y, Sameshima T, Miyao J, Tsurumaru T, Yoshimura N. The effects of sevoflurane anesthesia on insulin secretion and glucose metabolism in pigs. Anesth Analg 1997;84:1359-65.
• 14 Thorell A, Efendic S, Gutniak M, Häggmark T, Ljungqvist O. Insulin resistance after abdominal surgery. Br J Surg 1994;81:59-63.
• 15 Lattermann R, Carli F, Wykes L, Schricker T. Epidural blockade modifies perioperative glucose production without affecting protein catabolism. Anesthesiology 2002;97:374-81.
• 16 Lattermann R, Carli F, Wykes L, Schricker T. Perioperative glucose infusion and the catabolic response to surgery: The effect of epidural block. Anesth Analg 2003;96:555.
• 17 Ishii H, Arai T, Segawa H, Morikawa S, Inubushi T, Fukuda K. Effects of propofol on lactate accumulation and oedema formation in focal cerebral ischaemia in hyperglycaemic rats. Br J Anaesth 2002;88:412-7.
• 18 Nakahata K, Kinoshita H, Azma T, Matsuda N, Hama-Tomioka K, Haba M, et al. Propofol restores brain microvascular function impaired by high glucose via the decrease in oxidative stress. Anesthesiology 2008;108:269-75.
• 19 Jeong JS, Oh SW, Koo GH. Comparison of effects of propofol and enflurane on blood glucose level. Korean J Anesthesiol 1998;34:323-8.
• 20 Mahid SS, Polk HC Jr, Lewis JN, Turina M. Opportunities for improved performance in surgical specialty practice. Ann Surg 2008;247:380-8.
• 21 Kim H, Han J, Jung SM, Park SJ, Kwon NK. Comparison of sevoflurane and propofol anesthesia on the incidence of hyperglycemia in patients with type 2 diabetes undergoing lung surgery. Yeungnam Univ J Med 2018;35:54-62.
• 22 Gangakhedkar GR, Monteiro JN. A prospective randomized double-blind study to compare the early recovery profiles of desflurane and sevoflurane in patients undergoing laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol 2019;35:53-7.
• 23 Gökçek E, Kaydu A, Akdemir MS, Akil F, Akıncı IO. Early postoperative recovery after intracranial surgical procedures. Comparison of the effects of sevoflurane and desflurane. Acta Cir Bras 2016;31:638-44.
• 24 Song D, Joshi GP, White PF. Fast-track eligibility after ambulatory anesthesia: A comparison of desflurane, sevoflurane, and propofol. Anesth Analg 1998;86:267-73.
• 25 Marik PE. Propofol: Therapeutic indications and side-effects. Curr Pharm Des 2004;10:3639-49.
• 26 Iyilikci L, Balkan BK, Gökel E, Günerli A, Ellidokuz H. The effects of alfentanil or remifentanil pretreatment on propofol injection pain. J Clin Anesth 2004;16:499-502.
• 27 Agostoni M, Fanti L, Arcidiacono PG, Gemma M, Strini G, Torri G, et al. Midazolam and pethidine versus propofol and fentanyl patient controlled sedation/analgesia for upper gastrointestinal tract ultrasound endoscopy: A prospective randomized controlled trial. Dig Liver Dis 2007;39:1024-9.
• 28 Tang J, Chen L, White PF, Watcha MF, Wender RH, Naruse R, et al. Recovery profile, costs, and patient satisfaction with propofol and sevoflurane for fast-track office-based anesthesia. Anesthesiology 1999;91:253-61.