Volume kinetics of glucose 2

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Presentation transcript:

Volume kinetics of glucose 2 Volume kinetics of glucose 2.5% solution during laparoscopic cholecystectomy Sjöstrand F , Hahn R.G. British Journal of Anaesthesia Volume 92, Issue 4, Pages 485-492 (April 2004) DOI: 10.1093/bja/aeh095 Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 1 The model used to analyse the volume kinetics when an osmotic gradient acts like a driving force, f(t). Infused fluid expands a body fluid space v1 and enters, by virtue of osmosis, a distant fluid space v3. These fluid spaces have the baseline volumes V1 and V3. After metabolism, the fluid equilibrates at a rate determined by k31. The elimination of fluid is given by basal fluid losses, kb, and a renal mechanism, kr. In this study, fluid did not expand the dotted intermediate fluid space. British Journal of Anaesthesia 2004 92, 485-492DOI: (10.1093/bja/aeh095) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 2 The plasma glucose concentration during and after infusion of about 1.4 litres of glucose 2.5% with electrolytes over 60 min during laparoscopic cholecystectomy. (a) Mean values for all 12 patients. Error bars represent standard deviations. (b) Individual concentration–time curves and a simulation based on the averaged best estimates of the kinetic parameters. British Journal of Anaesthesia 2004 92, 485-492DOI: (10.1093/bja/aeh095) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 3 (a) Relationship between endogenous glucose production and the clearance of glucose during infusion of glucose 2.5% in 12 patients undergoing laparoscopic cholecystectomy and as obtained by reanalysis of previous volunteer experiments.12 Each point is one experiment. (b) The mean plasma insulin concentration in the 12 patients undergoing laparoscopic cholecystectomy. The error bars represent sd. British Journal of Anaesthesia 2004 92, 485-492DOI: (10.1093/bja/aeh095) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 4 The plasma dilution as calculated from Hb, RBC, and MCV during and after infusion of glucose 2.5%. (a) Absolute values for the group (n=12). The error bars represent standard deviations. (b) Individual concentration–time curves (thin lines) and a simulation based on the averaged best estimates of the kinetic parameters (thick line). (c) The plasma dilution decreased markedly at the time of awakening in several patients. A selection of individual curves is shown. British Journal of Anaesthesia 2004 92, 485-492DOI: (10.1093/bja/aeh095) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 5 The haemodynamic profile (mean and sd). Time zero is when surgery starts. British Journal of Anaesthesia 2004 92, 485-492DOI: (10.1093/bja/aeh095) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 6 Nomogram showing the relationship between infusion rate and infusion time required to increase plasma glucose concentration (a) and the infusion rate required thereafter to maintain a steady-state glucose concentration (b) during laparoscopic cholecystectomy in a patient weighing 75 kg. The isobars show the predicted glucose level. The computer simulations for the graph were performed using the average kinetic parameters from Table 1. Please note the different scales for rate on the vertical axes. British Journal of Anaesthesia 2004 92, 485-492DOI: (10.1093/bja/aeh095) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions

Fig 7 Nomogram showing the relationship between infusion rate and infusion time required to dilute the plasma to a predetermined degree (a) and the infusion rate required thereafter to maintain a steady-state dilution (b) during laparoscopic cholecystectomy in a patient weighing 75 kg. The steady-state rate is given for a 30-min infusion but should be increased by 3% for the shortest infusion rate (10 min) and reduced by 3% for the longest one (60 min). Please note the different scales for rate on the vertical axes. British Journal of Anaesthesia 2004 92, 485-492DOI: (10.1093/bja/aeh095) Copyright © 2004 British Journal of Anaesthesia Terms and Conditions