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CARDIOVASCULAR ANESTHESIA

Maintenance of Normoglycemia During Cardiac Surgery

George Carvalho, MD^*, Anne Moore, MD^*, Baqir Qizilbash, MD^*, Kevin Lachapelle, MD, and Thomas Schricker, MD PhD^*

Departments of *Anesthesia and Cardiac Surgery, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada

Address correspondence and reprint requests to George Carvalho and Thomas Schricker, Department of Anesthesia, McGill University, Royal Victoria Hospital, Room S5.05, 687 Pine Ave. West, Montreal, Quebec, Canada H3A 1A1. Address e-mail to thomas.schricker{at}mcgill.ca

We used the hyperinsulinemic normoglycemic clamp technique, i.e., infusion of insulin at a constant rate combined with dextrose titrated to clamp blood glucose at a specific level, to preserve normoglycemia during elective cardiac surgery. Ten nondiabetic and seven diabetic patients entered the clamp protocols. Perioperative glucose control was also assessed in 19 nondiabetic and 11 diabetic patients (control group) receiving a conventional insulin infusion sliding scale. In patients of the clamp group, a priming bolus of insulin (2 U) was started before the induction of anesthesia followed by infusions of insulin at 5 mU · kg^–1 · min^–1 and of variable amounts of dextrose. Arterial blood glucose was measured every 5 min in the clamp group and every 20 min in the control group. Control of normoglycemia was defined as 95% of the glucose levels within 4.0–6.0 mmol/L. Glucose concentration was recorded before surgery, 15 min before cardiopulmonary bypass (CPB), during early and late CPB, and at sternal closure. Patients of the control group became progressively hyperglycemic during surgery (late CPB; nondiabetics, 9.0 ± 3.2 mmol/L; diabetics, 10.1 ± 3.6 mmol/L), whereas normoglycemia was achieved in the study group (late CPB; nondiabetics, 5.5 ± 0.7 mmol/L; diabetics, 4.9 ± 0.6 mmol/L; P < 0.05 versus control group). In conclusion, it seems that normal blood glucose concentration during open heart surgery can be reliably maintained in nondiabetic and diabetic patients by using the hyperinsulinemic normoglycemic clamp technique.

IMPLICATIONS: The hyperinsulinemic normoglycemic clamp can be used to preserve normoglycemia during open heart surgery. This technique in combination with a continuous intravenous glucose monitoring system may be applied in future studies to investigate the effect of aggressive intraoperative glucose control on outcome after cardiac surgery.

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