title: Insulin and amino acid infusion after cardiac operations: effects on systemic and renal perfusion.
abstract: OBJECTIVE
  The purpose of this study was to answer two questions: (1) Does a mixed amino acid infusion enhance systemic and renal perfusion in the early postoperative period after heart operations? (2) Does the addition of insulin (glucose-insulin-potassium solution) provide additional effects to those of an amino acid infusion?
  
  
  METHODS
  Thirty-three male patients undergoing coronary artery bypass grafting (mean age 65.9 +/- 1.2 years) were included in a prospective, controlled, randomized study. Eleven patients (AA group) received infusion of mixed amino acids (11.4 gm), 11 patients (AA + GIK group) received infusion of mixed amino acids (11.4 gm) and insulin solution (225 IU insulin, glucose with glucose clamp technique, and potassium), and 11 patients served as control subjects.
  
  
  RESULTS
  Amino acid infusion alone had no effect on systemic vascular resistance or cardiac index but increased renal blood flow 51% +/- 11% (from 114 +/- 13 to 172 +/- 24 ml.min-1.m-2 in one kidney, p < 0.05 vs the control group). Insulin solution in addition to amino acid infusion reduced systemic vascular resistance 24% +/- 3% (from 1280 +/- 85 to 960 +/- 57 dyn.sec.cm-5, p < 0.05 vs the control and AA groups) and increased cardiac index 13% +/- 3% (from 2.3 +/- 0.2 to 2.6 +/- 0.2 L.min-1.m-2, p < 0.05 vs the control and AA groups). Insulin had no significant additive effect on renal blood flow.
  
  
  CONCLUSIONS
  Our data imply that (1) infusion of mixed amino acids enhances renal blood flow after cardiac operations but has no effect on systemic perfusion and (2) the addition of insulin solution improves systemic perfusion. The combined treatment may potentially reduce the risk of renal hypoperfusion injury in the postoperative period after coronary artery bypass grafting.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Jeppsson
authors.forename: R
authors.initials: R
authors.lastname: Ekroth
authors.forename: K
authors.initials: K
authors.lastname: Kirnö
authors.forename: I
authors.initials: I
authors.lastname: Milocco
authors.forename: B
authors.initials: B
authors.lastname: Nilsson
authors.forename: F
authors.initials: F
authors.lastname: Nilsson
authors.forename: S
authors.initials: S
authors.lastname: Svensson
authors.forename: J
authors.initials: J
authors.lastname: Wernerman
mesh_terms: D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000097:blood / Q000494:pharmacology*; D006348:Cardiac Surgical Procedures; D002314:Cardioplegic Solutions / Q000494:pharmacology*; D001026:Coronary Artery Bypass; D005947:Glucose / Q000494:pharmacology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007328:Insulin / Q000494:pharmacology; D007668:Kidney / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011188:Potassium / Q000494:pharmacology; D012079:Renal Circulation / Q000187:drug effects*
chemical_list: D000596:Amino Acids; D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium