Acute Hyperglycemia Induced by Ketamine/Xylazine Anesthesia in Rats: Mechanisms and Implications for Preclinical Models

The effects of anesthetic agents, commonly used in animal models, on blood glucose levels in fed and fasted rats were investigated. In fed Sprague-Dawley rats, ketamine (100 mg/kg)/xylazine (10 mg/kg) (KX) produced acute hyperglycemia (blood glucose 178.4 ± 8.0 mg/dl) within 20 min. The baseline blood glucose levels (104.8 ± 5.7 mg/dl) reached maximum levels (291.7 ± 23.8 mg/dl) at 120 min. Ketamine alone did not elevate glucose levels in fed rats. Isoflurane also produced acute hyperglycemia similar to KX. Administration of pentobarbital sodium did not produce hyperglycemia in fed rats. In contrast, none of these anesthetic agents produced hyperglycemia in fasted rats. The acute hyperglycemic effect of KX in fed rats was associated with decreased plasma levels of insulin, adrenocorticotropic hormone (ACTH), and corticosterone and increased levels of glucagon and growth hormone (GH). The acute hyperglycemic response to KX was dose-dependently inhibited by the specific Α2-adrenergic receptor antagonist yohimbine (1–4 mg/kg). KX-induced changes of glucoregulatory hormone levels such as insulin, GH, ACTH, and corticosterone were significantly altered by yohimbine, whereas the glucagon levels remained unaffected. In conclusion, the present study indicates that both KX and isoflurane produce acute hyperglycemia in fed rats. The effect of KX is mediated by modulation of the glucoregulatory hormones through stimulation of Α2-adrenergic receptors. Pentobarbital sodium did not produce hyperglycemia in either fed or fasted rats. Based on these findings, it is suggested that caution needs to be taken when selecting anesthetic agents, and fed or fasted state of animals in studies of diabetic disease or other models where glucose and/or glucoregulatory hormone levels may influence outcome and thus interpretation. However, fed animals are of value when exploring the hyperglycemic response to anesthetic agents.

[1]  S. Inoue,et al.  Alpha 2-adrenergic modulation of pancreatic glucagon secretion in rats , 1992, Physiology & Behavior.

[2]  P. Ernsberger,et al.  The Role of I1-Imidazoline and α2-Adrenergic Receptors in the Modulation of Glucose Metabolism in the Spontaneously Hypertensive Obese Rat Model of Metabolic Syndrome X , 2003, Journal of Pharmacology and Experimental Therapeutics.

[3]  R. P. Brockman Effect of xylazine on plasma glucose, glucagon and insulin concentrations in sheep. , 1981, Research in veterinary science.

[4]  H. Gerstein,et al.  Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview , 2000, The Lancet.

[5]  I. Lawrence,et al.  DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction): theory and practice , 2002, Diabetes, obesity & metabolism.

[6]  K. Alberti,et al.  Blood pressure response to glucose potassium insulin therapy in patients with acute stroke with mild to moderate hyperglycaemia , 2001, Journal of neurology, neurosurgery, and psychiatry.

[7]  Bergman Sa Ketamine: review of its pharmacology and its use in pediatric anesthesia. , 1999 .

[8]  N. Kawai,et al.  Hyperglycemia and the vascular effects of cerebral ischemia. , 1997, Acta neurochirurgica. Supplement.

[9]  A. Takeshita,et al.  Streptozotocin-induced hyperglycemia exacerbates left ventricular remodeling and failure after experimental myocardial infarction. , 2003, Journal of the American College of Cardiology.

[10]  H. M. Swartz,et al.  The effects of ketamine–xylazine anesthesia on cerebral blood flow and oxygenation observed using nuclear magnetic resonance perfusion imaging and electron paramagnetic resonance oximetry , 2001, Brain Research.

[11]  A. Arieff,et al.  Rapid inibition of basal and glucose-stimulated insulin release by xylazine. , 1979, Endocrinology.

[12]  H. Symonds,et al.  The effect of xylazine and xylazine followed by insulin on blood glucose and insulin in the dairy cow , 1978, Veterinary Record.

[13]  K. Hodate,et al.  Effects of atipamezole, an alpha 2-adrenergic antagonist, and somatostatin on xylazine-induced growth hormone release in calves. , 1996, Endocrine journal.

[14]  R. Marfella,et al.  Myocardial infarction in diabetic rats: role of hyperglycaemia on infarct size and early expression of hypoxia-inducible factor 1 , 2002, Diabetologia.

[15]  W. Feldberg,et al.  Hyperglycaemic effect of xylazine , 1980 .

[16]  M Schetz,et al.  Intensive insulin therapy in critically ill patients. , 2001, The New England journal of medicine.

[17]  T. Ambrisko,et al.  Neurohormonal and metabolic effects of medetomidine compared with xylazine in beagle dogs. , 2002, Canadian journal of veterinary research = Revue canadienne de recherche veterinaire.

[18]  C. Ricordi,et al.  Effects of ketamine sedation on glucose clearance, insulin secretion and counterregulatory hormone production in baboons (Papio hamadryas) , 1997, Journal of medical primatology.

[19]  K. Hodate,et al.  The effects of xylazine on plasma concentrations of growth hormone, insulin-like growth factor-I, glucose and insulin in calves. , 1996, Endocrine journal.

[20]  F. Horber,et al.  Anesthesia with Halothane and Nitrous Oxide Alters Protein and Amino Acid Metabolism in Dogs , 1988, Anesthesiology.

[21]  L. M. Linares,et al.  Adrenocorticotrophic hormone, cortisol and catecholamine concentrations during insulin hypoglycaemia in dogs anaesthetized with thiopentone , 1993, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[22]  T. Ambrisko,et al.  The antagonistic effects of atipamezole and yohimbine on stress-related neurohormonal and metabolic responses induced by medetomidine in dogs. , 2003, Canadian journal of veterinary research = Revue canadienne de recherche veterinaire.

[23]  W. Hsu,et al.  Xylazine-induced hyperglycemia in cattle: a possible involvement of alpha 2-adrenergic receptors regulating insulin release. , 1981, Endocrinology.

[24]  R. Jorde,et al.  Increased plasma glucose levels after Hypnorm® anaesthesia, but not after Pentobarbital® anaesthesia in rats , 1994, Laboratory animals.

[25]  Yan Cui,et al.  EFFECTS OF KETAMINE/XYLAZINE ON EXPRESSION OF TUMOR NECROSIS FACTOR‐&agr;, INDUCIBLE NITRIC OXIDE SYNTHASE, AND CYCLO‐OXYGENASE‐2 IN RAT GASTRIC MUCOSA DURING ENDOTOXEMIA , 2003, Shock.

[26]  E. Kraegen,et al.  Pentobarbital reduces basal liver glucose output and its insulin suppression in rats. , 1990, The American journal of physiology.

[27]  T. Issad,et al.  Effect of anesthesia on glucose production and utilization in rats. , 1987, The American journal of physiology.

[28]  Hsu Wh,et al.  Intravenous glucose tolerance test in cats: influenced by acetylpromazine, ketamine, morphine, thiopental, and xylazine. , 1982 .

[29]  M Wright,et al.  Pharmacologic effects of ketamine and its use in veterinary medicine. , 1982, Journal of the American Veterinary Medical Association.

[30]  W. Langhans,et al.  Metabolic concomitants of glucagon-induced suppression of feeding in the rat. , 1981, The American journal of physiology.

[31]  W. Schmiegel,et al.  Blood glucose control in healthy subject and patients receiving intravenous glucose infusion or total parenteral nutrition using glucagon-like peptide 1 , 2004, Regulatory Peptides.

[32]  N. Altszuler,et al.  Clonidine or xylazine as provocative tests for growth hormone secretion in the dog. , 1981, American journal of veterinary research.

[33]  T. Kent,et al.  How Important is Hyperglycemia During Acute Brain Infarction? , 2004, The neurologist.