Saori Sako

Effect of Glucose Administration on the Metabolism during Surgery

Background and aim: Glucose is stored mainly in the liver and muscles as glycogen. However, the total calories are less than basal energy expenditure for one day. Overnight fast before surgery may be stressful for patients. Therefore, we investigated the effect of glucose administration on the metabolic state during anesthesia. Methods: After getting written informed consent, patients undergoing maxillofacial surgery were randomly assigned to two groups throughout the surgical procedure, G group receiving acetated Ringer solution with 1.5% glucose (n=12) and R group receiving acetated Ringer solution without glucose (n=11). Anesthesia was maintained with remifentanil and sevoflurane. Blood glucose level was monitored continuously using the STG-22TM from after the induction of anesthesia. Plasma ketone bodies were evaluated before and after surgery. Respiratory quotient (RQ) was monitored continuously during anesthesia using the indirect calorimetry V-Max. Results: In G group (n=12), patients received 0.17 ± 0.03 g/kg/hr of glucose. But hyperglycemia did not observed during surgery. The mean blood glucose levels were maintained stably <150 mg/dL during surgery. The plasma concentration of ketone bodies was significantly higher at T4 in R group than in G group (p=0.027). However, it decreased from T1 to T3, T4 in G group. RQ decreased significantly from 0.93 ± 0.14 to 0.78 ± 0.11 in the R group (p=0.037), while it was kept at 0.88 ± 0.09 in the G group. There is no significant difference between group R and group G in REE during operation. Conclusion: Intraoperative 0.17 ± 0.03 g/kg/hr of glucose administration may suppress ketogenesis and can maintain glucose metabolism successfully without causing hyperglycemia.

Oral methotrexate-related lymphoproliferative disease presenting with severe osteonecrosis of the Jaw: A case report and literature review

Long-term methotrexate (MTX) treatment can cause MTX-related lymphoproliferative disorder (MTX-LPD). We experienced a case of MTX-LPD that was associated with severe osteonecrosis of the jaw mimicking medication-related osteonecrosis of the jaw. The patient was an 81-year-old woman with rheumatoid arthritis (RA) who was treated with MTX and bisphosphonate. After 7 years, she was referred to our department for the assessment of giant ulcer and exposure of the alveolar bone of the left maxilla. Histopathological and immunological analyses confirmed a diagnosis of MTX-LPD. At seven months after the cessation of MTX treatment, the ulcerative and necrotic lesions had markedly decreased in size. A 1-year follow-up examination showed no evidence of recurrence and good RA control.

Intra-operative administration of low-dose IV glucose attenuates post-operative insulin resistance

BACKGROUND & AIMS Insulin sensitivity often decreases after surgery in spite of normal insulin secretion, and may worsen the outcome. This post-operative insulin resistance increases according to the magnitude of surgical invasion. However, supplementation of carbohydrates before surgery attenuates the post-operative insulin resistance. This study aimed to investigate the effect of intra-operative administration of low-dose glucose on the post-operative insulin resistance. METHODS Patients undergoing maxillofacial surgery were randomly assigned to two groups throughout the surgical procedure: The glucose group receiving acetated Ringer solution with 1.5% glucose and the control group receiving acetated Ringer solution without glucose. Insulin resistance quantified by the mean glucose infusion rate (the glucose infusion rate) was evaluated by glucose clamp using the STG-22TM instrument on the previous day and on the next day of surgery. Blood glucose level was monitored continuously during surgery. In addition, serum insulin, ketone bodies and 3-methylhistidine were measured during perioperative period. RESULTS Patients in the glucose group (n=11) received 0.15 ± 0.06 g/kg/h of glucose during surgery, while patients in the control group (n=11) received no glucose. In both groups, however, the mean blood glucose levels were maintained stable at less than 150 mg/dL during and after surgery. The serum ketone bodies significantly increased after surgery in the control group (p=0.0035), while it decreased significantly in the glucose group (p=0.043). The reduction rate in the glucose infusion rate was significantly lower in the glucose group, 43.3 ± 20.7%, than that in the control group, 57.7 ± 9.3% (p=0.041). CONCLUSIONS Intra-operative small-dose of glucose administration may suppress ketogenesis and attenuate the post-operative insulin resistance without causing hyperglycemia.

The Effect of the Use of a Stabilizer and Different Height Settings on the Stability of the Dental Chair when Performing High-Quality Chest Compressions

Background/Aim: In the case of sudden cardiopulmonary arrest (CPA) in a patient in a dental practice, dental professionals have to perform cardiopulmonary resuscitation (CPR) in the dental chair. However, not all dental chairs are stable enough for performing chest compressions, as some do not contain steady support under the backrest. We investigated methods for stabilizing the dental chair to increase the efficacy of chest compressions performed in the chair. Materials and Methods: Chest compressions (with a depth of 5.0 to 6.0 cm) were performed on a CPR manikin that was laid on the backrest of a dental chair. The movement of the chest of the manikin and the displacement of the backrest caused by the chest compressions were recorded as video data, and the mean amplitude of the movement of the backrest at each compression depth was analyzed. We investigated the effect of three different height settings of the dental chair and the use of a round stool as a stabilizer under the backrest on the stability of the dental chair during CPR. Results: Differences in the height settings of the dental chair did not significantly affect the vertical movement of the backrest caused by chest compressions. The mean amplitudes of the movements of the backrest with and without a stabilizer were 1.99±0.74 cm and 0.43±0.18 cm, respectively. Conclusion: The placement of a round stool as a stabilizer under the backrest of a dental chair might increase the effectiveness of chest compressions.