TIVA has less impact on perioperative blood sugar and better cortisol release inhibition in type 2 diabetes patients

The study published in BMC Anesthesiology revealed the less impact of TIVA on perioperative blood glucose levels and a better inhibition of cortisol release in T2DM patients compared to TIHA.

Diabetes mellitus is a prevalent metabolic disease in the world. Previous studies have revealed that anaesthetics can affect perioperative blood glucose levels related to adverse clinical outcomes. Few studies have explored the choice of general anaesthetic protocol on perioperative glucose metabolism in diabetes patients.

Xinghui Xiong, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China, and colleagues aimed to compare total inhalation anaesthesia with total intravenous anaesthesia on blood glucose levels and complications in patients with type 2 diabetes undergoing general surgery.

The double-blind controlled trial included 116 T2DM patients scheduled for general surgery. They were randomly assigned to either the TIHA group or the TIVA group (n=60 and n = 56, respectively). They measured blood glucose levels at different time points and analyzed by the repeated-measures analysis of variance.

Measurement of serum insulin and cortisol levels was done and analyzed with a t-test. Complications incidence was followed up and analyzed with the chi-square test or Fisher's exact test as appropriate. The risk factors for complications were evaluated using the logistic stepwise regression.

The researchers revealed the following findings:

• The blood glucose levels were higher in the TIHA group than that in the TIVA group at the time points of extubation, 1 and 2 h after the operation, 1 and 2 days after the operation, and were significantly higher at 1 day after the operation (10.4 ± 2.8 versus 8.1 ± 2.1 mmol/L).
• The postoperative insulin level was higher in the TIVA group than that in the TIHA group (8.9 ± 2.9 versus 7.6 ± 2.4 IU/mL).
• The postoperative cortisol level was higher in the TIHA group than that in the TIVA group (15.3 ± 4.8 versus 12.2 ± 8.9 ug/dL).
• No significant difference regarding the incidence of complications between the two groups was found based on the current samples.
• Blood glucose level on postoperative day 1 was a risk factor for postoperative complications (OR: 1.779).

"We found that in type 2 diabetes patients undergoing general surgery, TIVA has less impact on perioperative blood glucose level and a better inhibition of cortisol release compared to TIHA," the researchers wrote. Due to the relative-short term of follow-up, it is impossible to compare postoperative survival time in our study."

"There is a need for conducting a future large trial to find the difference in long-term complications in patients with type 2 diabetes between TIVA and TIHA," they concluded.

Reference:

Xiong, X., He, Y., Zhou, C. et al. Impact of total intravenous anesthesia and total inhalation anesthesia as the anesthesia maintenance approaches on blood glucose level and postoperative complications in patients with type 2 diabetes mellitus: a double-blind, randomized controlled trial. BMC Anesthesiol 23, 267 (2023). https://doi.org/10.1186/s12871-023-02199-6