Plasma cortisol and blood sugar following minor surgery under intravenous anaesthetics

Pharmacodynamic responses of exogenous epinephrine during mandibular third molar surgery

Background:

The systemic effects attributable to the injection of dental local anesthetic solutions have been the subject of discussion for many years.

Aim and Objective:

The aim of the present study was to investigate the biochemical and hemodynamic effects of adrenaline in lignocaine local anesthetic solutions when used in clinical doses in patients undergoing third molar surgery under general anesthesia.

Materials and Methods:

Of the total 30 patients, 15 were given local anesthetic solution containing adrenaline and the other 15 were given the same without adrenaline. Hemodynamic and biochemical parameters were recorded at considerable intervals. The changes from the pre-local anesthetic (baseline) values with each treatment were compared by analysis of variance and Student's t-test. The changes within each treatment were compared by the paired t-test.

Results and Conclusion:

This study shows that exogenous adrenaline administration in clinical doses produces systemic effects even in conditions where the endogenous release of the catecholamines would be expected to be considerable.

Dysfunctional neurotransmitter systems in fibromyalgia, their role in central stress circuitry and pharmacological actions on these systems

Fibromyalgia is considered a stress-related disorder, and hypo- as well as hyperactive stress systems (sympathetic nervous system and hypothalamic-pituitary-adrenal axis) have been found. Some observations raise doubts on the view that alterations in these stress systems are solely responsible for fibromyalgia symptoms. Cumulative evidence points at dysfunctional transmitter systems that may underlie the major symptoms of the condition. In addition, all transmitter systems found to be altered in fibromyalgia influence the body's stress systems. Since both transmitter and stress systems change during chronic stress, it is conceivable that both systems change in parallel, interact, and contribute to the phenotype of fibromyalgia. As we outline in this paper, subgroups of patients might exhibit varying degrees and types of transmitter dysfunction, explaining differences in symptomatoloy and contributing to the heterogeneity of fibromyalgia. The finding that not all fibromyalgia patients respond to the same medications, targeting dysfunctional transmitter systems, further supports this hypothesis.

Glycemic control in non-diabetic critically ill patients

Hyperglycemia is a common and costly health care problem in hospitalized patients. In hospital hyperglycemia is defined as any glucose value >7.8 mmol/l (140 mg/dl). Hyperglycemia is present in 40% of critically ill patients and in up to 80% of patients after cardiac surgery, with ∼ 80% of ICU patients with hyperglycemia having no history of diabetes prior to admission. The risk of hospital complications relates to the severity of hyperglycemia, with a higher risk observed in patients without a history of diabetes compared to those with known diabetes. Improvement in glycemic control reduces hospital complications and mortality; however, the ideal glycemic target has not been determined. A target glucose level between 7.8 and 10.0 mmol/l (140 and 180 mg/dl) is recommended for the majority of ICU patients. This review aims to present updated recommendations for the inpatient management of hyperglycemia in critically ill patients with and without a history of diabetes.

Current perioperative treatment of patients with type 1 and type 2 diabetes

Diabetes mellitus is rapidly increasing, diabetic patients are likely to undergo surgical procedures more than non-diabetic patients, the hospital stay of diabetic patients is longer, and diabetic patients have increased mortality and morbidity. The correct treatment of diabetic patients in the perioperative period is crucial to improve clinical outcomes. Diabetic patients must be carefully evaluated for cardiovascular risk, keeping in mind micro- and macroangiopathic diabetic complications. Metabolic control deserves great attention because hyperglycemia is related to increased complications and worse outcomes. Insulin infusion regimens to achieve near normoglycemia must be implemented in surgical and critically ill patients.

Perioperative glucose control in the diabetic or nondiabetic patient

Patients with diabetes are more likely to undergo surgery than nondiabetics, and maintaining glycemic control in subjects with diabetes can be challenging during the perioperative period. Surgery in diabetic patients is associated with longer hospital stay, higher health care resource utilization, and greater perioperative mortality. In addition, several observational and interventional studies have indicated that hyperglycemia is associated with adverse clinical outcomes in surgical and critically ill patients. This paper reviews the pathophysiology of hyperglycemia during trauma and surgical stress and will provide practical recommendations for the preoperative, intraoperative, and postoperative care of diabetic patients.

The biochemical and haemodynamic effects of adrenaline in lignocaine local anaesthetic solutions in patients having third molar surgery under general anaesthesia

The effects of adrenaline-containing and adrenaline-free lignocaine local anaesthetic solutions injected in doses consistent with clinical practice on plasma potassium concentration, blood glucose levels and haemodynamic responses were investigated in 20 patients having third molar surgery under general anaesthesia. All patients received a standard general anaesthetic regime. Ten patients were given 4.0 ml of 2% lignocaine as an inferior dental and long buccal block during their general anaesthetic and the other 10 received 4.0 ml of 2% lignocaine containing 1:80000 adrenaline in the same manner. There were no significant differences between treatments in blood pressure or heart rate. However, there were significant differences between treatments in plasma potassium concentration and blood glucose levels.

[Development of blood sugar and insulinemia in the first 12 postoperative hours. Effects of glucose and insulin intake]

Serum levels of glucose and insulin are studied during 12 hours in the early post-operative period after intra-abdominal surgery. Five groups of non diabetic patients are perfused with incremental doses of glucose, G. I: no glucose, G. II: 8,33 g . h-1 of glucose during 6 hours, G. III: 16,66 g . h-1 of glucose during 6 hours, G. IV: 16,66 g . h-1 of glucose with 20 mu insulin; G. V: 16,66 g . h-1 of glucose with 40 mu insulin. In all groups a significant rise in serum levels of glucose is observed (10,5-15,6 mmol . l-1). At the same time serum level of insulin remains unchanged except when insulin is infused. However exogenous insulin is unable to prevent the serum level of glucose to rise post-operatively.

Total intravenous anaesthesia. A technique based on alphaxalone/alphadolone and pentazocine

Two hundred and eight patients were anaesthetised using incremental doses of intravenous alphaxalone/alphadolone (Althesin). Analgesia was provided by supplements of pentazocine, which also helped eliminate the excessive movements associated with pure Althesin anaesthesia. This is a total intravenous technique and consequently eliminates the problem of atmospheric pollution. It provides adequate anaesthesia for most minor surgical procedures.