BJA Advance Access originally published online on August 12, 2005
British Journal of Anaesthesia 2005 95(4):448-457; doi:10.1093/bja/aei220
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Glucose, insulin and potassium applied as perioperative hyperinsulinaemic normoglycaemic clamp: effects on inflammatory response during coronary artery surgery
Departments of 1 Anaesthesia, 2 Clinical Chemistry, 3 Epidemiology and Biostatistics, 4 Intensive Care and 5 Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
* Corresponding author. E-mail: H.B.vanWezel{at}amc.uva.nl
Background. The clinical benefits of glucose–insulin–potassium (GIK) and tight glycaemic control in patients undergoing coronary artery bypass grafting (CABG) may be partly explained by an anti-inflammatory effect. We applied GIK as a hyperinsulinaemic normoglycaemic clamp for >25 h and quantified its effect on systemic inflammation in patients undergoing CABG.
Methods. Data obtained in 21 non-diabetic patients with normal left ventricular function scheduled for elective coronary artery surgery, who were randomly allocated to a control or GIK group, were analysed. In GIK patients, regular insulin was infused at a fixed rate of 0.1 IU kg–1 h–1. The infusion rate of glucose (30%) was adjusted to maintain blood glucose levels within a target range of 4.0–5.5 mmol litre–1. Plasma concentrations of interleukins 6, 8 and 10, C-reactive protein (CRP) and serum amyloid A (SAA) were measured on the day of surgery and on the first and second postoperative days (POD1 and POD2).
Results. In the GIK group hypoglycaemia (glucose <2.2 mmol litre–1) did not occur, whereas hyperglycemia (glucose >6.1 mmol litre–1) developed in 15% of all measurements. In control patients, hyperglycaemia developed in >80% of all measurements in the presence of low endogenous insulin levels. CRP and SAA levels increased in both groups, with maximum levels measured on POD2. GIK treatment significantly reduced CRP and SAA levels. Interleukin levels increased significantly in both groups following cardiopulmonary bypass, but no differences were found between the groups.
Conclusion. Hyperinsulinaemic normoglycaemic clamp is an effective method of maintaining tight glycaemic control in patients undergoing CABG and it attenuates the systemic inflammatory response in these patients. This effect may partly contribute to the reported beneficial effect of glycaemic control in patients undergoing CABG.
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