Letters to the Editor
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DOI: 10.1213/ane.0b013e3181a909be
Increase in Blood Glucose
with the Start of the
Reperfusion After Large
Vessel Surgery
To the Editor:
The STG-22™ (Nikkiso, Tokyo, Ja-
pan) provides reliable continuous
glucose monitoring,1 and our recent
experience using this device revealed
an abrupt increase in blood glucose
concentrations with the start of reper-
fusion after large vessel surgery.
In two patients undergoing total
arch replacement for aortic arch an-
eurysm, continuous blood glucose
monitoring using the STG-22 was
started after induction of anesthesia.
The systemic circulation had been
interrupted for more than 60 min,
and blood glucose concentrations
had not changed significantly during
684 Letters to the Editor
Figure 1. In two cases of total arch replacement for aortic arch aneurysm (Cases 1 and
2), the glucose concentrations increased from 123 to 216 mg/dL (Case 1) and from 118
to 215 mg/dL (Case 2) in 5 min after the start of reperfusion. In one case of abdominal
aortic aneurysm resection with interruption of hepatic circulation, the glucose con-
centration increased from 163 to 252 mg/dL in the 5 min after the release of the aortic
cross-clamp proximal to the celiac artery (Case 3). We confirmed these increases in
blood glucose concentration before and after reperfusion with samples taken from the
radial artery and/or cardiopulmonary bypass using the ABL800FLEX (Radiometer
Medical Aps, Bronshoj, Denmark) (Case 1: blank circle, Case 2: black circle, Case 3:
blank square).
Kochi, Japan
this interruption. After completing
all anastomoses, retrograde perfu- yatabe@kochi-u.ac.jp
sion was started from the femoral Takehiro Okabayashi, MD, PhD
artery and the glucose concentrations Kazuhiro Hanazaki, MD, PhD
increased by more than 90 mg/dL in Department of Surgery
the 5 min after the start of reperfu- Kochi Medical School
Kochi, Japan
sion (Fig. 1). In a third patient under-
going abdominal aortic aneurysm
REFERENCES
resection with interruption of hepatic
arterial circulation, the blood glucose 1. Yamashita K, Okabayashi T, Yokoyama T,
Yatabe T, Maeda H, Manabe M, Hanazaki
concentration increased from 163 to K. The accuracy of a continuous blood
252 mg/dL after release of the clamp glucose monitor during surgery. Anesth
proximal to the celiac artery, whereas Analg 2008;106:160 –3
2. Ungerstedt J, Nowak G, Ungerstedt U,
no increase was observed in four Ericzon BG. Microdialysis monitoring of
cases without liver reperfusion. porcine liver metabolism during warm
A previous study described that ischemia with arterial and portal clamp-
ing. Liver Transpl 2009;15:280 – 6
glycogenolysis is triggered by he- 3. Martini SR, Kent TA. Hyperglycemia in acute
patic ischemia.2 Our findings might ischemic stroke: a vascular perspective.
contribute to perioperative glucose J Cereb Blood Flow Metab 2007;27:435–51
DOI: 10.1213/ane.0b013e3181a96456
control in patients undergoing large
vessel surgery and reduce any morbid- Effective Communication of
ity related to hyperglycemia, which, in Difficult Airway
turn, may increase the risk of ischemia- Management to Subsequent
reperfusion injury.3 Anesthesia Providers
Tomoaki Yatabe, MD
Takeshi Yokoyama, DDS, PhD
To the Editor:
Koichi Yamashita, MD, PhD
Department of Anesthesiology and Critical Care Clinicians frequently have prob-
Medicine lems obtaining important informa-
Kochi Medical School tion about a patient’s previous
ANESTHESIA & ANALGESIA