Improving Glycogen Liver Content Will Improve Post-operative Liver Function in Patients Undergoing Major Liver Resections

Keywords

• all adult patients (>18 years) planned to undergo a major liver resection

Lead sponsor

McGill University Health Centre/Research Institute of the McGill University Health Centre is the lead sponsor of 415 studies on the registry; 106 are open to participants now.

Study arms

• Placebo comparator
  Control Group

  Intravenous normal saline (NS 0.9) started just before induction, and titrated to hemodynamic parameters and urine output

  Drug: Intravenous normal saline (NS 0.9)

• Experimental
  GICP

  Drug: dextrose 10% (D10W ®) infusion · Drug: hyperinsulinemic normoglycemic clamp · Dietary Supplement: high calorie diet 35 kcal/kg

Interventions

• Drugdextrose 10% (D10W ®) infusion

  Started at 8pm the day before surgery until the procedure begins

• Drughyperinsulinemic normoglycemic clamp

  Started as the procedure begins, decreased at the end of the procedure and continued until 16 hours postoperatively

• Dietary supplementhigh calorie diet 35 kcal/kg

  High Calorie meals start the day before the surgery and are given 5 hours apart. The last meal is given at 7 pm the day before surgery

• DrugIntravenous normal saline (NS 0.9)

  Intravenous normal saline (NS 0.9) started just before induction, and titrated to hemodynamic parameters and urine output

Primary outcomes

1. Postoperative liver function test

   Time frame: Postoperative

Secondary outcomes

1. Liver and muscle glycogen, TG, and protein content at beginning and end of the procedure.

   Time frame: Begining + end of the procedure

2. Incidence of complications

   Time frame: Postoperative

Publications

• Hassanain M, Metrakos P, Fisette A, Doi SA, Schricker T, Lattermann R, Carvalho G, Wykes L, Molla H, Cianflone K. Randomized clinical trial of the impact of insulin therapy on liver function in patients undergoing major liver resection. Br J Surg. 2013 Apr;100(5):610-8. doi: 10.1002/bjs.9034. Epub 2013 Jan 21. PubMed 23339047 ↗
• Fisette A, Hassanain M, Metrakos P, Doi SA, Salman A, Schricker T, Lattermann R, Wykes L, Nitschmann E, Smith J, Cianflone K. High-dose insulin therapy reduces postoperative liver dysfunction and complications in liver resection patients through reduced apoptosis and altered inflammation. J Clin Endocrinol Metab. 2012 Jan;97(1):217-26. doi: 10.1210/jc.2011-1598. Epub 2011 Oct 26. PubMed 22031518 ↗
• Sato H, Lattermann R, Carvalho G, Sato T, Metrakos P, Hassanain M, Matsukawa T, Schricker T. Perioperative glucose and insulin administration while maintaining normoglycemia (GIN therapy) in patients undergoing major liver resection. Anesth Analg. 2010 Jun 1;110(6):1711-8. doi: 10.1213/ANE.0b013e3181d90087. Epub 2010 Apr 7. PubMed 20375299 ↗