0.15 0.16 PERIOPERATIVE ENTERAL GLUCOSE FEEDING - RESORPTION AND HORMONAL RESPONSt. M. Butters, R. Bittner, S. Metzger, H.G. Beger. Department of General Surqery, Univ. of Ulm, F-RG. It is not yet clear when nutrition should be started after major abdominal surgery. So far only i.v.-tests have been performed to clarify the carbohydrate metabolism intraoperatively and in the early postoperative period. The present study is the first to investigate resorption and hormonal response to an enteral glucose load in man intraoperatively and immediately after operation. Methods: By means of assisted pump infusion 15 g of glucose were intraduodenally infused via a filiform tube within 7.5 min (c 10 ml of a 10% solution/min). Blood samples were taken over 90 min. The study was started preoperatively and repeated intraoperatively as well as 3, 6, and 12 hours after operation in 12 patients under- going major abdominal surgery, who were of normal body weight and free of metabolic disorders. postop. n = 12 preop. intraop. 3 h 6h 12 h Blood qlucose - fasting values (mg/dl) 71.1 61.8 89.7 94.1 98.5 Rise of glucose (mg/dl/min) 1.41 0.39" 0.84 0.45" 0.86 Rise of insulin (@J/ml/min) 1.05 0.04" 0.19" 0.21* 0.16* Insulin-qlucose-index 0.37 0.11 0.16* 0.19 0.19 Somatostatin - fasting values (pg/ml) 64.8 72.8 74.1 74.1 48.3 * p < 0.01 Results: Glucose resorption is significantly hampered intraoperatively and 6 h postoperatively, and slightly less until 12 h postoperatively. Insulin secretion is significantly delayed up to 12 h postoperatively. The insulin-glucose-index demonstrates that the entero-insular axis is fairly disturbed in this period. High intraoperative fasting values of somatostatin correlate well with significantly reduced insulin values - 12 h postoperatively it is vice versa. These results show that enteral glucose application within 12 h after operation is not useful. IMPROVED UTILISATION OF HYPONITROGENOUS-HYPOCALORIC PERIPHERAL VEIN FEEDING WITH BIOSYNTHETIC HUMAN GROWTH HORMONE AFTER SURGERY. GA Panting, AJW Sim. Academic Surgical Unit, St Mary's Hospital Medical School, London W2. Previous studies have demonstrated that biosynthetic human growth hormone (BSHGH) improves nitrogen balance and increases fat oxidation in patients receiving either inadequate (5% dextrose) or total parenteral nutrition. This study investigates the effect of BSHGH on nitrogen balance and energy metabolism in patients receiving a hyponitrogenous (7gNiday) and hypocaloric (500 kcal from glucose, 450 kcal from fat) regimen administered through a peripheral vein for the first seven days after surgery. Si.xpatients received O.lmg BSHGH/kg/day and five placebo. The BSHGH group were significantly heavier (mean 62.5 , range 53-84kg) than the placebo group (mean 50.8, range 42-58kg). Four patients (one placebo and three BSHGH) failed to complete the seven day study. two (placebo and BSHGH) because of severe phlebitis and two (BSHGH) because of hyperglycaemia. Day Nitrogen Balance (gN/day) Fat oxidation (%REE) Placebo (n) BSHGH (Ii> Placebo (n) BSHGH (n) C -5.220.7 5 -5.6+0.4 6 26+10 5 32?5 6 1 -l.O?l.O 5 * 0.8+0.9 6 2125 5 * 4425 6 2 -0.9tO.6 5 * 0.4t1.3 6 2026 5 * 51210 6 3 -1.5t1.1 5 * 2.720.5 6 2127 5 * 5024 6 4 -0.6~0.8 4 * 2.451.1 4 18-+15 4 4524 4 5 -3.Oc2.1 4 * 2.9t0.7 4 23211 4 4922 4 6 -0.520.9 4 * 1.921.9 4 30210 4 * 50+2 4 7 0.2-cO.6 4. 1.921.8 3 29212 4 * 46+-Z 3 (results are mean + sem, * p<O.O5 Mann Whitney U) Mean resting energy expenditure was similar (placebo 104t1.7, BSHGH 108+3.2% control). These results demonstrate that during postoperative hyponitrogenous and hypocaloric intravenous nutrition nitrogen balance becomes positive and fat oxidation is doubled with the administration of BSHGH. 16

Perioperative enteral glucose feeding — Resorption and hormonal response

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Page 1: Perioperative enteral glucose feeding — Resorption and hormonal response

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PERIOPERATIVE ENTERAL GLUCOSE FEEDING - RESORPTION AND HORMONAL RESPONSt. M. Butters,

R. Bittner, S. Metzger, H.G. Beger. Department of General Surqery, Univ. of Ulm, F-RG.

It is not yet clear when nutrition should be started after major abdominal surgery. So far only i.v.-tests have been performed to clarify the carbohydrate metabolism intraoperatively and in the early postoperative period. The present study is the first to investigate resorption and hormonal response to an enteral glucose load in man intraoperatively and immediately after operation. Methods: By means of assisted pump infusion 15 g of glucose were intraduodenally infused via a filiform tube within 7.5 min (c 10 ml of a 10% solution/min). Blood samples were taken over 90 min. The study was started preoperatively and repeated intraoperatively as well as 3, 6, and 12 hours after operation in 12 patients under- going major abdominal surgery, who were of normal body weight and free of metabolic disorders.

postop. n = 12 preop. intraop. 3 h 6h 12 h Blood qlucose - fasting values (mg/dl) 71.1 61.8 89.7 94.1 98.5 Rise of glucose (mg/dl/min) 1.41 0.39" 0.84 0.45" 0.86 Rise of insulin (@J/ml/min) 1.05 0.04" 0.19" 0.21* 0.16* Insulin-qlucose-index 0.37 0.11 0.16* 0.19 0.19 Somatostatin - fasting values (pg/ml) 64.8 72.8 74.1 74.1 48.3 * p < 0.01

Results: Glucose resorption is significantly hampered intraoperatively and 6 h postoperatively, and slightly less until 12 h postoperatively. Insulin secretion is significantly delayed up to 12 h postoperatively. The insulin-glucose-index demonstrates that the entero-insular axis is fairly disturbed in this period. High intraoperative fasting values of somatostatin correlate well with significantly reduced insulin values - 12 h postoperatively it is vice versa. These results show that enteral glucose application within 12 h after operation is not useful.

IMPROVED UTILISATION OF HYPONITROGENOUS-HYPOCALORIC PERIPHERAL VEIN FEEDING WITH BIOSYNTHETIC HUMAN GROWTH HORMONE AFTER SURGERY. GA Panting, AJW Sim. Academic Surgical Unit, St Mary's Hospital Medical School, London W2.

Previous studies have demonstrated that biosynthetic human growth hormone (BSHGH) improves nitrogen balance and increases fat oxidation in patients receiving either inadequate (5% dextrose) or total parenteral nutrition. This study investigates the effect of BSHGH on nitrogen balance and energy metabolism in patients receiving a hyponitrogenous (7gNiday) and hypocaloric (500 kcal from glucose, 450 kcal from fat) regimen administered through a peripheral vein for the first seven days after surgery. Si.x patients received O.lmg BSHGH/kg/day and five placebo. The BSHGH group were significantly heavier (mean 62.5 , range 53-84kg) than the placebo group (mean 50.8, range 42-58kg). Four patients (one placebo and three BSHGH) failed to complete the seven day study. two (placebo and BSHGH) because of severe phlebitis and two (BSHGH) because of hyperglycaemia.

Day Nitrogen Balance (gN/day) Fat oxidation (%REE) Placebo (n) BSHGH (Ii> Placebo (n) BSHGH (n)

C -5.220.7 5 -5.6+0.4 6 26+10 5 32?5 6 1 -l.O?l.O 5 * 0.8+0.9 6 2125 5 * 4425 6 2 -0.9tO.6 5 * 0.4t1.3 6 2026 5 * 51210 6

3 -1.5t1.1 5 * 2.720.5 6 2127 5 * 5024 6 4 -0.6~0.8 4 * 2.451.1 4 18-+15 4 4524 4 5 -3.Oc2.1 4 * 2.9t0.7 4 23211 4 4922 4 6 -0.520.9 4 * 1.921.9 4 30210 4 * 50+2 4 7 0.2-cO.6 4. 1.921.8 3 29212 4 * 46+-Z 3

(results are mean + sem, * p<O.O5 Mann Whitney U) Mean resting energy expenditure was similar (placebo 104t1.7, BSHGH 108+3.2% control). These results demonstrate that during postoperative hyponitrogenous and hypocaloric intravenous nutrition nitrogen balance becomes positive and fat oxidation is doubled with the administration of BSHGH.