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

Nutrition
Hiroaki SatoThomas Schricker

Abstract

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. 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 24h. 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. 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 pat...Continue Reading

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Citations

Aug 7, 2013·Journal of Artificial Organs : the Official Journal of the Japanese Society for Artificial Organs·Tomoaki YatabeMasataka Yokoyama
Jan 25, 2011·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Martin Girard, Thomas Schricker
Jul 16, 2011·Journal of Cardiothoracic and Vascular Anesthesia·Hiroaki SatoThomas Schricker
Jul 21, 2015·The Journal of Thoracic and Cardiovascular Surgery·Alejandro A FlohSteven M Schwartz
May 28, 2011·Metabolism: Clinical and Experimental·Roupen HatzakorzianThomas Schricker
Mar 21, 2020·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Alejandro A FlohSteven M Schwartz
Dec 23, 2016·Journal of Anesthesia·Alaa Abd-ElsayedAndra Duncan
May 11, 2021·Biosensors & Bioelectronics·Yuliang ZhaoLianqing Liu

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