JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
 QUICK SEARCH:   [advanced]


     


This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (44)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chaney, M. A.
Right arrow Articles by Bakhos, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chaney, M. A.
Right arrow Articles by Bakhos, M.
Anesth Analg 1999;89:1091
© 1999 International Anesthesia Research Society


CARDIOVASCULAR ANESTHESIA

Attempting to Maintain Normoglycemia During Cardiopulmonary Bypass with Insulin May Initiate Postoperative Hypoglycemia

Mark A. Chaney, MD*, Mihail P. Nikolov, MD*, Bradford P. Blakeman, MD{dagger}, and Mamdouh Bakhos, MD{dagger}

Departments of *Anesthesiology and {dagger}Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois

Address correspondence and reprint requests to Mark A. Chaney, MD, Department of Anesthesiology, Loyola University Medical Center, Foster G. McGaw Hospital, 2160 S. First Ave., Maywood, IL 60153. Address e-mail to MCHANEY{at}LUC.EDU

We attempted to develop an insulin administration protocol that maintains normoglycemia in patients undergoing cardiac surgery and to study the effects of intraoperative blood glucose management on serum levels of creatine phosphokinase isoenzyme BB (CK-BB) and S-100 protein. Twenty nondiabetic patients were randomly allocated to receive either "tight control" of blood glucose with a standardized IV insulin infusion intraoperatively (Group TC) or "no control" of blood glucose intraoperatively (Group NC). Perioperative serum levels of glucose, CK-BB, and S-100 protein were determined in all patients. Group TC patients received 90.0 ± 49.2 units of insulin, whereas Group NC patients received none. Despite insulin, both Group TC (P = 0.00026) and Group NC (P = 0.00003) experienced similar significant increases in blood glucose levels during hypothermic cardiopulmonary bypass. However, mean blood glucose level upon intensive care unit arrival was significantly decreased in Group TC, compared with Group NC (84.7 ± 41.0 mg/dL, range 32–137 mg/dL vs 201.4 ± 67.5 mg/dL, range 82–277 mg/dL, respectively; P = 0.0002). Forty percent of Group TC patients required treatment for postoperative hypoglycemia (blood glucose level <60 mg/dL). Substantial interindividual variability existed in regard to insulin resistance. The investigation was terminated after we realized that normoglycemia was unattainable with the study protocol and that postoperative hypoglycemia was unpredictable. All patients in both groups experienced similar significant increases in postoperative serum levels of CK-BB and S-100 protein. These results indicate that "tight control" of intraoperative blood glucose in nondiabetic patients undergoing cardiac surgery was unattainable with the study protocol and may initiate postoperative hypoglycemia.

Implications: The appropriate intraoperative management of hyperglycemia and whether it adversely affects neurologic outcome in patients after cardiac surgery remains controversial. This investigation reveals that attempting to maintain normoglycemia in this setting with insulin may initiate postoperative hypoglycemia.




This article has been cited by other articles:


Home page
Ann. Thorac. Surg.Home page
P. Knapik, P. Nadziakiewicz, E. Urbanska, W. Saucha, M. Herdynska, and M. Zembala
Cardiopulmonary Bypass Increases Postoperative Glycemia and Insulin Consumption After Coronary Surgery.
Ann. Thorac. Surg., June 1, 2009; 87(6): 1859 - 1865.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
H. L. Lazar, M. McDonnell, S. R. Chipkin, A. P. Furnary, R. M. Engelman, A. R. Sadhu, C. R. Bridges, C. K. Haan, R. Svedjeholm, H. Taegtmeyer, et al.
The society of thoracic surgeons practice guideline series: blood glucose management during adult cardiac surgery.
Ann. Thorac. Surg., February 1, 2009; 87(2): 663 - 669.
[Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
T. Albacker, G. Carvalho, T. Schricker, and K. Lachapelle
High-Dose Insulin Therapy Attenuates Systemic Inflammatory Response in Coronary Artery Bypass Grafting Patients
Ann. Thorac. Surg., July 1, 2008; 86(1): 20 - 27.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
P. Lecomte, L. Foubert, F. Nobels, J. Coddens, G. Nollet, F. Casselman, P. V. Crombrugge, G. Vandenbroucke, and G. Cammu
Dynamic Tight Glycemic Control During and After Cardiac Surgery Is Effective, Feasible, and Safe
Anesth. Analg., July 1, 2008; 107(1): 51 - 58.
[Abstract] [Full Text] [PDF]


Home page
Mayo Clin Proc.Home page
G. Y. Gandhi, M. H. Murad, D. N. Flynn, P. J. Erwin, A. B. Cavalcante, H. B. Nielsen, S. E. Capes, K. Thorlund, V. M. Montori, and P. J. Devereaux
Effect of Perioperative Insulin Infusion on Surgical Morbidity and Mortality: Systematic Review and Meta-analysis of Randomized Trials
Mayo Clin. Proc., April 1, 2008; 83(4): 418 - 430.
[Abstract] [Full Text] [PDF]


Home page
Asian Cardiovasc. Thorac. Ann.Home page
T. S. Shine, M. Uchikado, C. C Crawford, and M. J Murray
Importance of Perioperative Blood Glucose Management in Cardiac Surgical Patients
Asian Cardiovasc Thorac Ann, December 1, 2007; 15(6): 534 - 538.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
M. C. Torjman, M. E. Goldberg, R. A. Hirsh, and J. Littman
Thinking Like A Pancreas: A Look Ahead at Diabetes Technology in the Perioperative Setting
Anesth. Analg., August 1, 2007; 105(2): 545 - 545.
[Full Text] [PDF]


Home page
Eur Heart J SupplHome page
Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. V. d. Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al.
Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)
Eur. Heart J. Suppl., June 1, 2007; 9(suppl_C): C3 - C74.
[Full Text] [PDF]


Home page
ANN INTERN MEDHome page
G. Y. Gandhi, G. A. Nuttall, M. D. Abel, C. J. Mullany, H. V. Schaff, P. C. O'Brien, M. G. Johnson, A. R. Williams, S. M. Cutshall, L. M. Mundy, et al.
Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery: A Randomized Trial
Ann Intern Med, February 20, 2007; 146(4): 233 - 243.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al.
Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)
Eur. Heart J., January 1, 2007; 28(1): 88 - 136.
[Full Text] [PDF]


Home page
Anesth. Analg.Home page
C. W. Hogue Jr, C. A. Palin, and J. E. Arrowsmith
Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices.
Anesth. Analg., July 1, 2006; 103(1): 21 - 37.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
J. Butterworth, L. E. Wagenknecht, C. Legault, D. J. Zaccaro, N. D. Kon, J. W. Hammon Jr, A. T. Rogers, B. T. Troost, D. A. Stump, C. D. Furberg, et al.
Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting
J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1319 - 1319.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
S. Schubert, G. Stoltenburg-Didinger, A. Wehsack, D. Troitzsch, W. Boettcher, M. Huebler, M. Redlin, M. Kanaan, M. Meissler, P. E. Lange, et al.
Large-Dose Pretreatment with Methylprednisolone Fails to Attenuate Neuronal Injury After Deep Hypothermic Circulatory Arrest in a Neonatal Piglet Model
Anesth. Analg., November 1, 2005; 101(5): 1311 - 1318.
[Abstract] [Full Text] [PDF]


Home page
Br J AnaesthHome page
L. Visser, C. J. Zuurbier, F. J. Hoek, B. C. Opmeer, E. de Jonge, B. A. J. M. de Mol, and H. B. van Wezel
Glucose, insulin and potassium applied as perioperative hyperinsulinaemic normoglycaemic clamp: effects on inflammatory response during coronary artery surgery
Br. J. Anaesth., October 1, 2005; 95(4): 448 - 457.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
J. K. Koskenkari, P. K. Kaukoranta, K. T. Kiviluoma, M.J. P. Raatikainen, P. P. Ohtonen, and T. I. Ala-Kokko
Metabolic and Hemodynamic Effects of High-Dose Insulin Treatment in Aortic Valve and Coronary Surgery
Ann. Thorac. Surg., August 1, 2005; 80(2): 511 - 517.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
G. Carvalho, A. Moore, B. Qizilbash, K. Lachapelle, and T. Schricker
Maintenance of Normoglycemia During Cardiac Surgery
Anesth. Analg., August 1, 2004; 99(2): 319 - 324.
[Abstract] [Full Text] [PDF]


Home page
PerfusionHome page
R. C Groom, A. J Rassias, J. E Cormack, G. R DeFoe, C. DioDato, C. K Krumholz, R. J Forest, J. W Pieroni, B. O'Connor, C. S Warren, et al.
Highest core temperature during cardiopulmonary bypass and rate of mediastinitis
Perfusion, March 1, 2004; 19(2): 119 - 125.
[Abstract] [PDF]


Home page
SEMIN CARDIOTHORAC VASC ANESTHHome page
H. B. van Wezel and S. W. M. d. Jong
Clinical Use of Glucose-Insulin-Potassium in Cardiac Surgery andAcute Myocardial Infarction: An Overview
Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2003; 7(1): 77 - 83.
[PDF]


Home page
Anesth. Analg.Home page
T. Schricker, A. J. Rassias, and M. P. Yeager
On the Failure of Insulin to Affect Hyperglycemia During Cardiac Surgery * Response
Anesth. Analg., December 1, 2002; 95(6): 1823 - 1824.
[Full Text] [PDF]


Home page
Anesth. Analg.Home page
A. J. Rassias, A. L. Givan, C. A. S. Marrin, K. Whalen, J. Pahl, and M. P. Yeager
Insulin Increases Neutrophil Count and Phagocytic Capacity After Cardiac Surgery
Anesth. Analg., May 1, 2002; 94(5): 1113 - 1119.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
B. P. Conroy, M. R. Grafe, L. W. Jenkins, A. H. Vela, C. Y. Lin, D. S. DeWitt, and W. E. Johnston
Histopathologic consequences of hyperglycemic cerebral ischemia during hypothermic cardiopulmonary bypass in pigs
Ann. Thorac. Surg., April 1, 2001; 71(4): 1325 - 1334.
[Abstract] [Full Text] [PDF]




Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 1999 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1999 by the International Anesthesia Research Society.