EFFECT OF HYPOTENSIVE DRUGS ON PLASMA LEVELS OF GLUCOSE AND INSULIN AFTER GLUCOSE ADMINISTRATION UNDER GENERAL ANESTHESIA

Plasma glucose and insulin level after glucose administration(intravenous glucose tolerance test)were measured in 21 patients before surgery during hypotension induced by trimetaphan,nitroglycerin or prostaglandin E under isoflurane anesthesia.Systolic blood pressure was maintained at approximately 80±5 mmHg by continuous infusion of the hypotensive drug more than 15 minutes.Blood samples were obtained at the start of the procedure(control) and 1,3,5,10,20 and 30 minutes after infusion of 20 g of glucose to measure plasma levels of glucose and insulin.During the intravenous glucose tolerance test,plasma glucose levels did not change significantly in any patients.Plasma insulin levels in patients given prostaglandin E group were however significantly lower than those in the other patients.The insulinogenic index and the acute insulin response,which were calculated in relation to the plasma levels of glucose and insulin,were significantly lower in patients given prostaglandin E than in patients given trimetaphan or nitroglycerin.The glucose clearance rate was also lowest in patients given prostaglandin E.Our findings suggest that prostaglandin E should not be used as an agent for hypotensive anesthesia in patients with diabetes melitus. Instead,we recommend that trimetaphan or nitroglycerin should be used for hypotensive anesthesia in patients with disorders of glucose metabolism. (Tokyo Jikeikai Medical Journal 2006;121:55-61)