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. 2023 Feb 7;23:43. doi: 10.1186/s12871-023-02000-8

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© The Author(s) 2023

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 1 — KEMCT-evoked influences on isoflurane anesthesia-generated changes in blood glucose and R-βHB levels and recovery time. Blood glucose and R-βHB levels significantly increased after isoflurane-evoked anesthesia (7^th water gavage + isoflurane anesthesia: 7thW and Isoflu; group 1) (A and B). KEMCT (mix of ketone ester/KE and medium chain triglyceride/MCT oil in a 1:1 ratio) treatment for 7 days abolished the isoflurane-generated increase in blood glucose level (7^th KEMCT gavage + isoflurane anesthesia: 7thK and Isoflu; group 2) (C). After both 1^st KEMCT treatment (1stK) alone (without anesthesia) and 7^th KEMCT treatment combined with isoflurane anesthesia (7thK and Isoflu; group 2), blood R-βHB levels were increased (D). In KEMCT treated animals (7thK and Isoflu; group 2) the time required for recovery from isoflurane-evoked anesthesia significantly increased, compared to water gavaged and isoflurane-anesthetized animals (7thW and Isoflu; group 1) (E). Abbreviations: 7thK and Isoflu, 7^th KEMCT gavage and isoflurane anesthesia; 7thW and Isoflu, 7.^th water gavage and isoflurane anesthesia; **p < 0.01; ***p < 0.001; ****p < 0.0001