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Hypolipidaemic effects of high-dose insulin therapy
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Insulin administration in the perioperative period has been advocated for many years, for a variety of potential therapeutic benefits, but has failed to find universal application or favour. Although considerations have focused on clinical improvements, unwanted deleterious effects of insulin have been largely ignored. This is striking given that the potential for insulin to cause harm is great, especially if inadequately monitored, but unsurprising since it has many effects which are not all measurable. The study by Zuurbier and colleagues1 in this issue of the British Journal of Anaesthesia highlights potentially hazardous metabolic effects of high-dose insulin administration on lipid metabolism during cardiac surgery and provides an important and previously overlooked element of the use of insulin as a therapeutic adjunct.
Confusion has arisen regarding the rationale for using insulin during and after surgery and in the various other clinical scenarios advocated for its use. Insulin may be administered in
Nuffield Department of Anaesthetics
University of Oxford
Radcliffe Infirmary
Woodstock Road
Oxford OX2 6HE
UK
* E-mail: rhys.evans@nda.ox.ac.uk
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