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CARDIOVASCULAR ANESTHESIA

Insulin Increases Neutrophil Count and Phagocytic Capacity After Cardiac Surgery

Athos J. Rassias, MD^*, Alice L. Givan, PhD, Charles A. S. Marrin, MB BS, Kate Whalen, RN^*, Janice Pahl, BS^*, and Mark P. Yeager, MD^*

Departments of *Anesthesiology, Physiology, and Surgery, Dartmouth Medical School, Hanover, New Hampshire; and the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Address correspondence to Athos J. Rassias, MD, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756. Address e-mail to Athos.J.Rassias@ Hitchcock.org.

We previously reported that a continuous insulin infusion improves neutrophil phagocytic function after cardiac surgery in diabetic patients. These data suggested that hyperglycemia impairs neutrophil function, and because nondiabetic patients also experience hyperglycemia during cardiac surgery, we hypothesized that a continuous insulin infusion would improve glucose control and neutrophil function in nondiabetic cardiac surgical patients. Patients were randomized to receive either no insulin (Control group) or a continuous insulin infusion (Insulin group), with glucose measurements every 10 min during cardiopulmonary bypass (CPB). Blood glucose was significantly lower in the Insulin group immediately after surgery but not during surgery. When assessed as the percentage of phagocytic cells, neutrophil function was similar in the Control and Insulin groups at baseline (55% and 57%, respectively) and after CPB (38% and 43%, respectively). However, a quantitative determination of neutrophil phagocytic activity showed that whole blood neutrophil phagocytic capacity increased significantly in both groups at 60 min after CPB when compared with their respective baseline values and that the increase in total neutrophil phagocytic capacity was significantly more in the Insulin group compared with the Control group (P = 0.036). This observation was primarily due to a larger increase in the peripheral blood neutrophil count and not to increased activation of neutrophils.

IMPLICATIONS: IV insulin, as used in this study, had effects on blood glucose only after cardiac surgery, when it was associated with an increased neutrophil count and a greater total capacity of peripheral blood neutrophils to ingest foreign particles.

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