Perioperative tight glucose control with hyperinsulinemic-normoglycemic clamp technique in cardiac surgery
Received 6 July 2009; accepted 13 October 2009. published online 25 January 2010. Corrected Proof
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 15–30min. Dextrose 20% was infused at a rate adjusted to maintain BG within 3.5–6.1mmol/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 <2.2mmol/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.
Dr. Sato is supported by a grant from the Research Institute of Yamanashi University, Japan. Drs. Carvalho and Lattermann are supported by grants from the Research Institute of the McGill University Health Center, Montreal, Canada. Dr. Schricker is receiving funds from the Canadian Institutes of Health Research, Ottawa, Canada.
ABSTRACT
min. Dextrose 20% was infused at a rate adjusted to maintain BG within 3.5–6.1