Glucose Infusion Instead of Preoperative Fasting Reduces Postoperative Insulin Resistance

Comment: It is not apparent from the presentation of data what amounts of glucose were given during the study. A 70-kg patient having a preoperative infusion for a 12-hr period would have received a total of 252 g of glucose. This was given as a 20% solution with 40 mmol of potassium chloride/L. In this example a total of 1260 mL of glucose solution would have been administered. Unfortunately there is no indication from the data as to the effect of this infusion on fluid balance. Any differences in intraoperative responses to stress as shown by hormone levels would not have been revealed by the present study protocol. However, as the authors point out in this discussion, the preservation of body glucose stores might have an advantageous effect should there be significant intraoperative hemorrhage. It must be stressed that this study was performed in patients without major systemic disease and in whom the operative intervention did not cause major metabolic problems. Thus, although a major preoperative glucose infusion may be to the advantage of surgical patients, it has still to be established whether this is so in the presence of other disease processes and what the effect on responses to intraoperative blood losses and other such problems may be. Moreover, given the ever-increasing percentage of patients coming to the hospital on the day of surgery, rather titan the night before surgery, one must question the feasibility of 12-hr preoperative glucose infusion.