BJA Advance Access published online on August 12, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei220
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 Department of Anaesthesia, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
* To whom correspondence should be addressed. 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.
Accepted July 11, 2005
Clinical Investigation
Glucose, insulin and potassium applied as perioperative hyperinsulinaemic normoglycaemic clamp: effects on inflammatory response during coronary artery surgery
2 Department of Clinical Chemistry, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
3 Department of Epidemiology and Biostatistics, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
4 Department of Intensive Care, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
5 Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
H. B. van Wezel, E-mail: H.B.vanWezel{at}amc.uva.nl
Abstract 
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  N. R. Webster and H. F. Galley Does strict glucose control improve outcome? Br. J. Anaesth., September 1, 2009; 103(3): 331 - 334. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kosiborod, S. E. Inzucchi, H. M. Krumholz, F. A. Masoudi, A. Goyal, L. Xiao, P. G. Jones, S. Fiske, and J. A. Spertus Glucose Normalization and Outcomes in Patients With Acute Myocardial Infarction Arch Intern Med, March 9, 2009; 169(5): 438 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Dandona, A. Chaudhuri, H. Ghanim, and P. Mohanty Insulin as an anti-inflammatory and antiatherogenic modulator. J. Am. Coll. Cardiol., February 3, 2009; 53(5 Suppl): S14 - S20. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kosiborod Blood glucose and its prognostic implications in patients hospitalised with acute myocardial infarction Diabetes and Vascular Disease Research, November 1, 2008; 5(4): 269 - 275. [Abstract] [PDF]
|
|
|
|
 |
|
 H. Ghanim, P. Mohanty, R. Deopurkar, C. Ling Sia, K. Korzeniewski, S. Abuaysheh, A. Chaudhuri, and P. Dandona Acute Modulation of Toll-Like Receptors by Insulin Diabetes Care, September 1, 2008; 31(9): 1827 - 1831. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Albacker, G. Carvalho, T. Schricker, and K. Lachapelle High-Dose Insulin Therapy Attenuates Systemic Inflammatory Response in Coronary Artery Bypass Grafting Patients Ann. Thorac. Surg., July 1, 2008; 86(1): 20 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Zuurbier, F. J. Hoek, J. van Dijk, N. G. Abeling, J. C. M. Meijers, J. H. M. Levels, E. de Jonge, B. A. de Mol, and H. B. Van Wezel Perioperative hyperinsulinaemic normoglycaemic clamp causes hypolipidaemia after coronary artery surgery Br. J. Anaesth., April 1, 2008; 100(4): 442 - 450. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. Evans and Y. Niu Hypolipidaemic effects of high-dose insulin therapy Br. J. Anaesth., April 1, 2008; 100(4): 429 - 433. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Y. Gandhi, M. H. Murad, D. N. Flynn, P. J. Erwin, A. B. Cavalcante, H. B. Nielsen, S. E. Capes, K. Thorlund, V. M. Montori, and P. J. Devereaux Effect of Perioperative Insulin Infusion on Surgical Morbidity and Mortality: Systematic Review and Meta-analysis of Randomized Trials Mayo Clin. Proc., April 1, 2008; 83(4): 418 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Deedwania, M. Kosiborod, E. Barrett, A. Ceriello, W. Isley, T. Mazzone, and P. Raskin Hyperglycemia and Acute Coronary Syndrome: A Scientific Statement From the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism Circulation, March 25, 2008; 117(12): 1610 - 1619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Dandona Effects of Antidiabetic and Antihyperlipidemic Agents on C-Reactive Protein Mayo Clin. Proc., March 1, 2008; 83(3): 333 - 342. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Zuurbier, P. J. M. Keijzers, A. Koeman, H. B. Van Wezel, and M. W. Hollmann Anesthesia's Effects on Plasma Glucose and Insulin and Cardiac Hexokinase at Similar Hemodynamics and Without Major Surgical Stress in Fed Rats Anesth. Analg., January 1, 2008; 106(1): 135 - 142. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Chaudhuri, M. Miller, R. Nesto, N. Rosenberg, and P. Dandona Targeting Glucose in Acute Myocardial Infarction: Has glucose, insulin, and potassium infusion missed the target? Diabetes Care, December 1, 2007; 30(12): 3026 - 3028. [Full Text] [PDF]
|
|
|
|
|
|
P. F. White, H. Kehlet, J. M. Neal, T. Schricker, D. B. Carr, F. Carli, and the Fast-Track Surgery Study Group The Role of the Anesthesiologist in Fast-Track Surgery: From Multimodal Analgesia to Perioperative Medical Care Anesth. Analg., June 1, 2007; 104(6): 1380 - 1396. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. B. van Wezel, C. J. Zuurbier, E. de Jonge, E. W. C. M. van Dam, J. van Dijk, E. Endert, B. A. de Mol, and E. Fliers Differential Effects of a Perioperative Hyperinsulinemic Normoglycemic Clamp on the Neurohumoral Stress Response during Coronary Artery Surgery J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 4144 - 4153. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. A. Smit and J. A. Romijn Acute insulin resistance in myocardial ischemia: causes and consequences. Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2006; 10(3): 215 - 219. [Abstract] [PDF]
|
|
|
|
|
|
H. B. Van Wezel Glucose-insulin-potassium techniques in cardiac surgery: historical overview and future perspectives. Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2006; 10(3): 224 - 227. [Abstract] [PDF]
|
|
|
|
|
|
G. Carvalho, S. Leung, T. Schricker, H. B. Van Wezel, C. J. Zuurbier, J. van Dijk, F. J. Hoek, E. de Jonge, and B. A. de Mol Hyperinsulinaemic normoglycaemic clamp in coronary artery surgery Br. J. Anaesth., January 1, 2006; 96(1): 140 - 141. [Full Text] [PDF]
|
|