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Perioperative tight glucose control with hyperinsulinemic-normoglycemic clamp technique in cardiac surgery
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...
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| Published in: | Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2010-11, Vol.26 (11), p.1122-1129 |
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| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1016/j.nut.2009.10.005 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_759131233</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0899900709004298</els_id><sourcerecordid>759131233</sourcerecordid><originalsourceid>FETCH-LOGICAL-c489t-7ea46e5aca0ed9118f62196b4b22a766849b35fd9b14dbf92d031198e6c8ec043</originalsourceid><addsrcrecordid>eNp9kl2L1DAUhoMo7rj6A7zRgohXHU-SfgVBkMUvWFBY9zqk6WknY5vMJulK_72pM7qwF94knPC8Jy_vOYQ8p7ClQKu3-62d45YBiFRvAcoHZEObmueUFcVDsoFGiFwA1GfkSQh7AKCiEo_J2SqpS842ZP8dvXEH9CqaW8yiGXYxG8ZZu4CZdjZ6N2a_TNxluyVRxoZ5NBYno3Pr_OSGcdFrlelRTYcsot5ZczNjZmymle-M0lmY_YB-eUoe9WoM-Ox0n5PrTx9_XHzJL799_nrx4TLXRSNiXqMqKiyVVoCdoLTpK5Zst0XLmKqrqilEy8u-Ey0turYXrANOqWiw0g1qKPg5eXPse_AuOQlRTiZoHEdl0c1B1qWgnDLOE_nqHrl3s7fJnKSUA6tpCjJR9Ehp70Lw2MuDN5Pyi6Qg1znIvUxzkGuo61OaQ9K8OHWe2wm7f4q_wSfg9QlQQaux98pqE-44zuuqbqrEvTxyvXJSDT4x11cMkjsqgJZ_vnp3JDBlemvQy6ANWo2d8aij7Jz5r9H399Q6zdckSz9xwXCXhwxMgrxaV2rdKEhHwUTDfwNMEMUd</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1130271124</pqid></control><display><type>article</type><title>Perioperative tight glucose control with hyperinsulinemic-normoglycemic clamp technique in cardiac surgery</title><source>ScienceDirect Freedom Collection</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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 <2.2 mmol/L, were recorded. Results The mean BG remained within target at all times. Normoglycemia in non-diabetic patients was achieved in 92.8% of measurements during and in 83.2% after surgery. In diabetic patients 87.4% of values were within target intraoperatively and 76.7% after surgery. The rate of severe hypoglycemia was 2.7% (three patients). In non-diabetic patients the incidence of severe hypoglycemia was 0.2% of measurements during and 0.1% after surgery. Diabetic patients showed only one episode of severe hypoglycemia after surgery (0.1%). Conclusion Perioperative use of a hyperinsulinemic-normoglycemic clamp technique established and maintained normoglycemia in patients undergoing cardiac surgery with little risk of hypoglycemia.</description><identifier>ISSN: 0899-9007</identifier><identifier>EISSN: 1873-1244</identifier><identifier>DOI: 10.1016/j.nut.2009.10.005</identifier><identifier>PMID: 20097532</identifier><identifier>CODEN: NUTRER</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>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</subject><ispartof>Nutrition (Burbank, Los Angeles County, Calif.), 2010-11, Vol.26 (11), p.1122-1129</ispartof><rights>Elsevier Inc.</rights><rights>2010 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c489t-7ea46e5aca0ed9118f62196b4b22a766849b35fd9b14dbf92d031198e6c8ec043</citedby><cites>FETCH-LOGICAL-c489t-7ea46e5aca0ed9118f62196b4b22a766849b35fd9b14dbf92d031198e6c8ec043</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23376786$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20097532$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sato, Hiroaki, M.D</creatorcontrib><creatorcontrib>Carvalho, George, M.D., M.Sc</creatorcontrib><creatorcontrib>Sato, Tamaki, M.D</creatorcontrib><creatorcontrib>Bracco, David, M.D., Ph.D</creatorcontrib><creatorcontrib>Codere-Maruyama, Takumi</creatorcontrib><creatorcontrib>Lattermann, Ralph, M.D., Ph.D</creatorcontrib><creatorcontrib>Hatzakorzian, Roupen, M.D</creatorcontrib><creatorcontrib>Matsukawa, Takashi, M.D., Ph.D</creatorcontrib><creatorcontrib>Schricker, Thomas, M.D., Ph.D</creatorcontrib><title>Perioperative tight glucose control with hyperinsulinemic-normoglycemic clamp technique in cardiac surgery</title><title>Nutrition (Burbank, Los Angeles County, Calif.)</title><addtitle>Nutrition</addtitle><description>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 <2.2 mmol/L, were recorded. Results The mean BG remained within target at all times. Normoglycemia in non-diabetic patients was achieved in 92.8% of measurements during and in 83.2% after surgery. In diabetic patients 87.4% of values were within target intraoperatively and 76.7% after surgery. The rate of severe hypoglycemia was 2.7% (three patients). In non-diabetic patients the incidence of severe hypoglycemia was 0.2% of measurements during and 0.1% after surgery. Diabetic patients showed only one episode of severe hypoglycemia after surgery (0.1%). Conclusion Perioperative use of a hyperinsulinemic-normoglycemic clamp technique established and maintained normoglycemia in patients undergoing cardiac surgery with little risk of hypoglycemia.</description><subject>Aged</subject><subject>Anesthesia</subject><subject>Biological and medical sciences</subject><subject>Blood Glucose</subject><subject>cardiac surgery</subject><subject>Cardiac Surgical Procedures</subject><subject>Cardiopulmonary Bypass</subject><subject>Cohort Studies</subject><subject>Coronary Artery Bypass</subject><subject>Coronary Artery Disease - blood</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - surgery</subject><subject>Diabetes</subject><subject>Diabetic Cardiomyopathies - blood</subject><subject>Diabetic Cardiomyopathies - surgery</subject><subject>Feeding. Feeding behavior</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Gastroenterology and Hepatology</subject><subject>Glucose</subject><subject>Glucose Clamp Technique - adverse effects</subject><subject>glucose tolerance</subject><subject>glycemic control</subject><subject>glycemic effect</subject><subject>heart</subject><subject>heart diseases</subject><subject>Heart Valve Diseases - blood</subject><subject>Heart Valve Diseases - complications</subject><subject>Heart Valve Diseases - surgery</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Hyperglycemia - prevention & control</subject><subject>hyperinsulinemia</subject><subject>hyperinsulinemic-normoglycemic clamp technique</subject><subject>Hypoglycemia</subject><subject>Hypoglycemia - epidemiology</subject><subject>Hypoglycemia - prevention & control</subject><subject>Incidence</subject><subject>Insulin</subject><subject>Intensive care unit</subject><subject>Intensive insulin therapy</subject><subject>Intraoperative Period</subject><subject>Male</subject><subject>Middle Aged</subject><subject>patients</subject><subject>Perioperative Care - adverse effects</subject><subject>Perioperative Care - methods</subject><subject>perioperative tight glucose control</subject><subject>Postoperative Period</subject><subject>surgery</subject><subject>Veins & arteries</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><issn>0899-9007</issn><issn>1873-1244</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNp9kl2L1DAUhoMo7rj6A7zRgohXHU-SfgVBkMUvWFBY9zqk6WknY5vMJulK_72pM7qwF94knPC8Jy_vOYQ8p7ClQKu3-62d45YBiFRvAcoHZEObmueUFcVDsoFGiFwA1GfkSQh7AKCiEo_J2SqpS842ZP8dvXEH9CqaW8yiGXYxG8ZZu4CZdjZ6N2a_TNxluyVRxoZ5NBYno3Pr_OSGcdFrlelRTYcsot5ZczNjZmymle-M0lmY_YB-eUoe9WoM-Ox0n5PrTx9_XHzJL799_nrx4TLXRSNiXqMqKiyVVoCdoLTpK5Zst0XLmKqrqilEy8u-Ey0turYXrANOqWiw0g1qKPg5eXPse_AuOQlRTiZoHEdl0c1B1qWgnDLOE_nqHrl3s7fJnKSUA6tpCjJR9Ehp70Lw2MuDN5Pyi6Qg1znIvUxzkGuo61OaQ9K8OHWe2wm7f4q_wSfg9QlQQaux98pqE-44zuuqbqrEvTxyvXJSDT4x11cMkjsqgJZ_vnp3JDBlemvQy6ANWo2d8aij7Jz5r9H399Q6zdckSz9xwXCXhwxMgrxaV2rdKEhHwUTDfwNMEMUd</recordid><startdate>20101101</startdate><enddate>20101101</enddate><creator>Sato, Hiroaki, M.D</creator><creator>Carvalho, George, M.D., M.Sc</creator><creator>Sato, Tamaki, M.D</creator><creator>Bracco, David, M.D., Ph.D</creator><creator>Codere-Maruyama, Takumi</creator><creator>Lattermann, Ralph, M.D., Ph.D</creator><creator>Hatzakorzian, Roupen, M.D</creator><creator>Matsukawa, Takashi, M.D., Ph.D</creator><creator>Schricker, Thomas, M.D., Ph.D</creator><general>Elsevier Inc</general><general>[New York]: Elsevier Science Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RQ</scope><scope>7RV</scope><scope>7TS</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20101101</creationdate><title>Perioperative tight glucose control with hyperinsulinemic-normoglycemic clamp technique in cardiac surgery</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-7ea46e5aca0ed9118f62196b4b22a766849b35fd9b14dbf92d031198e6c8ec043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Anesthesia</topic><topic>Biological and medical sciences</topic><topic>Blood Glucose</topic><topic>cardiac surgery</topic><topic>Cardiac Surgical Procedures</topic><topic>Cardiopulmonary Bypass</topic><topic>Cohort Studies</topic><topic>Coronary Artery Bypass</topic><topic>Coronary Artery Disease - blood</topic><topic>Coronary Artery Disease - complications</topic><topic>Coronary Artery Disease - surgery</topic><topic>Diabetes</topic><topic>Diabetic Cardiomyopathies - blood</topic><topic>Diabetic Cardiomyopathies - surgery</topic><topic>Feeding. Feeding behavior</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Gastroenterology and Hepatology</topic><topic>Glucose</topic><topic>Glucose Clamp Technique - adverse effects</topic><topic>glucose tolerance</topic><topic>glycemic control</topic><topic>glycemic effect</topic><topic>heart</topic><topic>heart diseases</topic><topic>Heart Valve Diseases - blood</topic><topic>Heart Valve Diseases - complications</topic><topic>Heart Valve Diseases - surgery</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Hyperglycemia - prevention & control</topic><topic>hyperinsulinemia</topic><topic>hyperinsulinemic-normoglycemic clamp technique</topic><topic>Hypoglycemia</topic><topic>Hypoglycemia - epidemiology</topic><topic>Hypoglycemia - prevention & control</topic><topic>Incidence</topic><topic>Insulin</topic><topic>Intensive care unit</topic><topic>Intensive insulin therapy</topic><topic>Intraoperative Period</topic><topic>Male</topic><topic>Middle Aged</topic><topic>patients</topic><topic>Perioperative Care - adverse effects</topic><topic>Perioperative Care - methods</topic><topic>perioperative tight glucose control</topic><topic>Postoperative Period</topic><topic>surgery</topic><topic>Veins & arteries</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sato, Hiroaki, M.D</creatorcontrib><creatorcontrib>Carvalho, George, M.D., M.Sc</creatorcontrib><creatorcontrib>Sato, Tamaki, M.D</creatorcontrib><creatorcontrib>Bracco, David, M.D., Ph.D</creatorcontrib><creatorcontrib>Codere-Maruyama, Takumi</creatorcontrib><creatorcontrib>Lattermann, Ralph, M.D., Ph.D</creatorcontrib><creatorcontrib>Hatzakorzian, Roupen, M.D</creatorcontrib><creatorcontrib>Matsukawa, Takashi, M.D., Ph.D</creatorcontrib><creatorcontrib>Schricker, Thomas, M.D., Ph.D</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Career & Technical Education Database</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Databases</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Biological Sciences</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Nutrition (Burbank, Los Angeles County, Calif.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sato, Hiroaki, M.D</au><au>Carvalho, George, M.D., M.Sc</au><au>Sato, Tamaki, M.D</au><au>Bracco, David, M.D., Ph.D</au><au>Codere-Maruyama, Takumi</au><au>Lattermann, Ralph, M.D., Ph.D</au><au>Hatzakorzian, Roupen, M.D</au><au>Matsukawa, Takashi, M.D., Ph.D</au><au>Schricker, Thomas, M.D., Ph.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perioperative tight glucose control with hyperinsulinemic-normoglycemic clamp technique in cardiac surgery</atitle><jtitle>Nutrition (Burbank, Los Angeles County, Calif.)</jtitle><addtitle>Nutrition</addtitle><date>2010-11-01</date><risdate>2010</risdate><volume>26</volume><issue>11</issue><spage>1122</spage><epage>1129</epage><pages>1122-1129</pages><issn>0899-9007</issn><eissn>1873-1244</eissn><coden>NUTRER</coden><abstract>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 <2.2 mmol/L, were recorded. Results The mean BG remained within target at all times. Normoglycemia in non-diabetic patients was achieved in 92.8% of measurements during and in 83.2% after surgery. In diabetic patients 87.4% of values were within target intraoperatively and 76.7% after surgery. The rate of severe hypoglycemia was 2.7% (three patients). In non-diabetic patients the incidence of severe hypoglycemia was 0.2% of measurements during and 0.1% after surgery. Diabetic patients showed only one episode of severe hypoglycemia after surgery (0.1%). Conclusion Perioperative use of a hyperinsulinemic-normoglycemic clamp technique established and maintained normoglycemia in patients undergoing cardiac surgery with little risk of hypoglycemia.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20097532</pmid><doi>10.1016/j.nut.2009.10.005</doi><tpages>8</tpages></addata></record> |
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| identifier | ISSN: 0899-9007 |
| ispartof | Nutrition (Burbank, Los Angeles County, Calif.), 2010-11, Vol.26 (11), p.1122-1129 |
| issn | 0899-9007 1873-1244 |
| language | eng |
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| source | ScienceDirect Freedom Collection |
| 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 |
| title | Perioperative tight glucose control with hyperinsulinemic-normoglycemic clamp technique in cardiac surgery |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T18%3A02%3A55IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Perioperative%20tight%20glucose%20control%20with%20hyperinsulinemic-normoglycemic%20clamp%20technique%20in%20cardiac%20surgery&rft.jtitle=Nutrition%20(Burbank,%20Los%20Angeles%20County,%20Calif.)&rft.au=Sato,%20Hiroaki,%20M.D&rft.date=2010-11-01&rft.volume=26&rft.issue=11&rft.spage=1122&rft.epage=1129&rft.pages=1122-1129&rft.issn=0899-9007&rft.eissn=1873-1244&rft.coden=NUTRER&rft_id=info:doi/10.1016/j.nut.2009.10.005&rft_dat=%3Cproquest_cross%3E759131233%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c489t-7ea46e5aca0ed9118f62196b4b22a766849b35fd9b14dbf92d031198e6c8ec043%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1130271124&rft_id=info:pmid/20097532&rfr_iscdi=true |