Insulin Therapy in Patients Undergoing Liver Surgery

Tissue injury related to liver surgery stimulates the release of stress hormones and proinflammatory cytokines to produce the necessary elements needed for healing. An exaggerated stress limits the liver's capacity to regenerate by depleting its energy stores. This change in metabolism leads to an insulin resistant state in the patient and associated hyperglycaemia. Dextrose supplementation coupled with intravenous insulin given perioperatively affords superior surgical outcomes through preservation of liver glycogen and strict glycaemia control. The goal of this work was to investigate the benefits of a metabolic support protocol involving carbohydrate loading and insulin infusion provided by a hyperinsulinemic normoglycaemic clamp, for patients undergoing major hepatic resection.