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Recursos del Cáncer > Notícias sobre Cáncer > 2009 > octubre
Artificial pancreas helpful after pancreatic resection
David Douglas
Last Updated: 2009-10-30 15:10:03 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Perioperative use of an artificial pancreas allows precise glucose control after pancreatic resection, Japanese researchers report in the October 1st Archives of Surgery.
The device "enabled strict but gradual control of blood glucose to near normal levels, without severe hypoglycemia, even in patients undergoing total pancreatectomy," lead investigator Dr. Takehiro Okabayashi told Reuters Health.
Dr. Okabayashi and colleagues at Kochi Medical School conducted a randomized trial in 30 patients undergoing resection for cancer. In 17 subjects, the researchers used the STG-22 artificial endocrine pancreas (Nikkiso), which they describe as a closed-loop glycemic control system that maintains stable blood glucose concentrations via automatic infusion of regular insulin or glucose into the circulation. In these patients, blood glucose levels reduced steadily after surgery, reaching the target zone of 80 to 110 mg/dL within 6 hours.
In the remaining 13 patients, blood glucose was controlled with the sliding scale method. In this group, glucose levels rose postoperatively, reaching a plateau of about 200 mg/dL between 4 and 6 hours after surgery and remaining high for 18 hours postoperatively.
During the first 18 hours, total insulin use per patient was significantly higher in the artificial pancreas group (107 versus 8 IU). No patient in either group had hypoglycemia.
Dr. Okabayashi and colleagues have used this approach in other groups. "The artificial pancreas is of great clinical value in patients undergoing hepatic and pancreatic resection," he added. "It is an easy and effective way to control postoperative hyperglycemia induced by hepatogenic, pancreatogenic diabetes and surgical stress."
"In our experience of more than 200 patients in the surgical and medical ICU," he concluded, "we have not seen hypoglycemia develop in any patient when intensive insulin therapy is administered using a closed-loop glycemic control system."
Arch Surg 2009:144;933-937.
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