Metabolism: clinical and experimental
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Surgical stress with inhalation anesthesia is associated with increased circulating catecholamines, hyperglycemia, and impaired insulin secretion. These changes do not occur during surgical stress with spinal anesthesia, suggesting that they are neurally mediated due to pain initiated afferents from the site of tissue trauma. ⋯ In the postoperative period, however, suppressed insulin secretion was found to be correlated with elevated plasma epinephrine concentrations and may, therefore, be mediated by adrenergic mechanisms. Thus, these findings indicate that impaired insulin secretion during surgical stress may have two etiologies--one related to the type of anesthesia used and the other due to adrenomedullary stimulation due to pain.