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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.
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