Perioperative tight glucose control with hyperinsulinemic-normoglycemic clamp technique in cardiac surgery

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2010-11, Vol.26 (11), p.1122-1129
• Main Authors: Sato, Hiroaki, M.D, Carvalho, George, M.D., M.Sc, Sato, Tamaki, M.D, Bracco, David, M.D., Ph.D, Codere-Maruyama, Takumi, Lattermann, Ralph, M.D., Ph.D, Hatzakorzian, Roupen, M.D, Matsukawa, Takashi, M.D., Ph.D, Schricker, Thomas, M.D., Ph.D
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia; Biological and medical sciences; Blood Glucose; cardiac surgery; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Cohort Studies; Coronary Artery Bypass; Coronary Artery Disease - blood; Coronary Artery Disease - complications; Coronary Artery Disease - surgery; Diabetes; Diabetic Cardiomyopathies - blood; Diabetic Cardiomyopathies - surgery; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Glucose; Glucose Clamp Technique - adverse effects; glucose tolerance; glycemic control; glycemic effect; heart; heart diseases; Heart Valve Diseases - blood; Heart Valve Diseases - complications; Heart Valve Diseases - surgery; Humans; Hyperglycemia; Hyperglycemia - prevention & control; hyperinsulinemia; hyperinsulinemic-normoglycemic clamp technique; Hypoglycemia; Hypoglycemia - epidemiology; Hypoglycemia - prevention & control; Incidence; Insulin; Intensive care unit; Intensive insulin therapy; Intraoperative Period; Male; Middle Aged; patients; Perioperative Care - adverse effects; Perioperative Care - methods; perioperative tight glucose control; Postoperative Period; surgery; Veins & arteries; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2009.10.005

Abstract Objective Previous attempts to achieve tight glucose control in surgical patients were associated with a significant incidence of hypoglycemia. The purpose of this study was to evaluate the efficacy of perioperative glucose and insulin administration while maintaining normoglycemia using a hyperinsulinemic-normoglycemic clamp technique. Methods We studied 70 non-diabetic and 40 diabetic patients undergoing cardiac procedures. Before induction of anesthesia, insulin was administered at 5 mU · kg−1 · min−1 . Blood glucose (BG) concentrations were determined every 15–30 min. Dextrose 20% was infused at a rate adjusted to maintain BG within 3.5–6.1 mmol/L. At the end of surgery, insulin infusion was decreased to 1 mU · kg−1 · min−1 and continued for 24 h. The mean ± standard deviation of BG and the percentage of BG values within the target range were calculated perioperatively. Episodes of severe hypoglycemia, i.e., BG