Is skeletal muscle luxury perfusion the main hemodynamic effect of high-dose insulin in cardiac surgery?
Insulin, in combination with glucose and potassium (GIK), can be used in heart surgery to improve hemodynamic performance. This study evaluates the role of skeletal muscle vasodilation in hemodynamic effects of high-dose GIK therapy early after coronary surgery. Thirty-three male patients undergoing coronary artery bypass grafting were included in a prospective, randomized and controlled study. Eleven patients received infusions of mixed amino acids (11.4 g) and insulin solution (225 IU insulin, glucose with the glucose clamp technique, and potassium), 11 patients received infusions of mixed amino acids (11.4 g) and 11 patients served as control subjects. During combined insulin and amino acid infusion, cardiac output increased by 13+/-3% (+0.6+/-0.2 L x min(-1)) and systemic vascular resistance decreased by 24+/-3% (-320+/-46 dyn x s x cm(-5)). The changes differed from those in the control group (CO: -0.2+/-0.1 L x min(-1), p < 0.05; SVR: +136+/-42 dyn x s x cm(-5), p < 0.05). Changes in skeletal muscle perfusion and leg vascular resistance did not differ significantly among the groups. At most, changes in leg blood flow could explain 40% of the changes in cardiac output. Skeletal muscle luxury perfusion is not the main hemodynamic effect of high-dose insulin in the early postoperative period after coronary surgery.
Lindholm
L
L
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
Nilsson
B
B
Kirnö
K
K
Sellgren
J
J
Nilsson
F
F
Jeppsson
A
A
D000368:Aged; D000369:Aged, 80 and over; D000596:Amino Acids / Q000008:administration & dosage*; D000704:Analysis of Variance; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005947:Glucose / Q000008:administration & dosage*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000187:drug effects; D011188:Potassium / Q000008:administration & dosage*; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012039:Regional Blood Flow / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects
D000596:Amino Acids; D007328:Insulin; D005947:Glucose; D011188:Potassium