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BJA Advance Access originally published online on February 27, 2008
British Journal of Anaesthesia 2008 100(4):442-450; doi:10.1093/bja/aen018
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Perioperative hyperinsulinaemic normoglycaemic clamp causes hypolipidaemia after coronary artery surgery{dagger}

C. J. Zuurbier1,*, F. J. Hoek5, J. van Dijk1, N. G. Abeling6, J. C. M. Meijers4, J. H. M. Levels4, E. de Jonge3, B. A. de Mol2 and H. B. Van Wezel1

1 Department of Anaesthesiology
2 Department of Cardiac Surgery
3 Department of Intensive Care Medicine
4 Department of Vascular Medicine
5 Laboratory of Clinical Chemistry
6 Laboratory of Genetic Metabolic Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

* Corresponding author. E-mail: c.j.zuurbier{at}amc.uva.nl

Background: Glucose–insulin–potassium (GIK) administration is advocated on the premise of preventing hyperglycaemia and hyperlipidaemia during reperfusion after cardiac interventions. Current research has focused on hyperglycaemia, largely ignoring lipids, or other substrates. The present study examines lipids and other substrates during and after on-pump coronary artery bypass grafting and how they are affected by a hyperinsulinaemic normoglycaemic clamp.

Methods: Forty-four patients were randomized to a control group (n=21) or to a GIK group (n=23) receiving a hyperinsulinaemic normoglycaemic clamp during 26 h. Plasma levels of free fatty acid (FFA), total and lipoprotein (VLDL, HDL, and LDL)-triglycerides (TG), ketone bodies, and lactate were determined.

Results: In the control group, mean FFA peaked at 0.76 (SEM 0.05) mmol litre–1 at early reperfusion and decreased to 0.3–0.5 mmol litre–1 during the remaining part of the study. GIK decreased FFA levels to 0.38 (0.05) mmol litre–1 at early reperfusion, and to low concentrations of 0.10 (0.01) mmol litre–1 during the hyperinsulinaemic clamp. GIK reduced the area under the curve (AUC) for FFA by 75% and for TG by 53%. The reduction in total TG was reflected by a reduction in the VLDL (–54% AUC) and HDL (–42% AUC) fraction, but not in the LDL fraction. GIK prevented the increase in ketone bodies after reperfusion (–44 to –47% AUC), but was without effect on lactate levels.

Conclusions: Mild hyperlipidaemia was only observed during early reperfusion (before heparin reversal) and the hyperinsulinaemic normoglycaemic clamp actually resulted in hypolipidaemia during the largest part of reperfusion after cardiac surgery.

Keywords: metabolism, insulin; metabolism, lipid; surgery, cardiovascular; surgery, metabolic response

{dagger} This article is accompanied by Editorial I.


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