Stress-Induced Hyperglycemia in Non-Diabetic Patients Undergoing Laparoscopic Cholecystectomy under General Anesthesia: A Prospective Observational Study

Abstract

Background: Though surgical trauma triggers the neuroendocrine stress response, the contribution of general anesthetic agents along with minimally invasive surgery is not well defined in metabolically healthy populations. This prospective study measured the incidence and magnitude of stress-induced hyperglycemia in healthy nondiabetic patients undergoing elective laparoscopic cholecystectomy under general anesthesia and investigated the metabolic effects of anesthesia.

 Methodology: After IRB approval, this prospective observational study was conducted over a 6-month period at Mayo Hospital, Lahore, Pakistan. 41 non-diabetic patients of ASA physical status I, scheduled for elective laparoscopic cholecystectomy, were included in the study. Anesthesia was induced with propofol (2 mg/kg), nalbuphine (0.1 mg/kg), and atracurium and maintained with isoflurane and oxygen. Capillary blood glucose was measured within 15 minutes before induction ( T0 ) and within 15 minutes after tracheal extubation (T1) using a calibrated glucometer. Postoperative capillary blood glucose ≥140 mg/dL was considered stress-induced hyperglycemia. It was further categorized into moderate (140-179 mg/dL) and severe (≥180 mg/dL) categories.

 Results: The study population (N=41) was predominantly female (80.5%), with a mean age of 36.51±8.00 years and a mean anesthesia duration of 109.63±21.13 minutes. Mean capillary blood glucose rose significantly from 108.71±11.38 mg/dL preoperatively to 166.00±31.20 mg/dL postoperatively, representing a mean systemic glycemic excursion of +57.29 mg/dL (p<0.001). The overall incidence of postoperative stress-induced hyperglycemia was 65.9% (n=27). Moderate hyperglycemia developed in 26.8% (n=11) of patients, while 39.0% (n=16) developed severe hyperglycemia, associated with a mean post-extubation glucose level of 182.31±25.94 mg/dL.    Conclusions: Non-diabetic patients undergoing elective laparoscopic cholecystectomy under volatile general anesthesia experience a high incidence of postoperative stress-induced hyperglycemia. Despite the minimally invasive nature of laparoscopic surgery, the combination of volatile anesthesia and carbon dioxide pneumoperitoneum triggers significant metabolic stress. Routine perioperative blood glucose monitoring is warranted in non-diabetic cohorts to facilitate early identification and therapeutic intervention.