title: Insulin (GIK) improves central mixed and hepatic venous oxygenation in clinical cardiac surgery.
abstract: OBJECTIVE
  Insulin is a vasodilating agent and it was hypothesized that insulin (GIK) could improve systemic and regional oxygenation in cardiac surgery with cardiopulmonary bypass (CPB). Two questions were addressed: 1) Does insulin improve central mixed and hepatic venous oxygenation during CPB? and 2) Does this treatment reduce systemic levels of the proinflammatory mediators C3a and IL-6?
  
  
  METHODS
  Prospective, randomized, controlled study at a university hospital. Thirty patients were included and 16 of these received an infusion of insulin, glucose and potassium (GIK) using an euglycemic clamp technique. The insulin infusion was started during hypothermia, 15 min before rewarming. Blood gases and hemodynamic parameters were measured during hypothermia (before the insulin infusion was started), during rewarming at 35 degrees C, and 30 min after CPB was discontinued. Inflammatory markers were measured: preoperatively, during hypothermia and 2 h after CPB.
  
  
  RESULTS
  GIK was associated with reduced systemic vascular resistance (p = 0.02 vs the control group), higher bypass pump flow (p = 0.001). higher central mixed oxygen saturation (p = 0.036) and oxygen tension (p = 0.001) and higher hepatic venous oxygen saturation (p = 0.04) and oxygen tension (p = 0.006). C3a and IL-6 increased during surgery in both groups but there were no differences between the groups.
  
  
  CONCLUSIONS
  1) GIK infusion improved central mixed and hepatic venous oxygenation in patients undergoing heart surgery. 2) During the conditions of this study, this had no effect on the proinflammatory mediators C3a and IL-6.
authors.affiliation: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Lindholm
authors.forename: A
authors.initials: A
authors.lastname: Bengtsson
authors.forename: V
authors.initials: V
authors.lastname: Hansdottir
authors.forename: A
authors.initials: A
authors.lastname: Westerlind
authors.forename: A
authors.initials: A
authors.lastname: Jeppsson
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D005260:Female; D005947:Glucose / Q000627:therapeutic use*; D015309:Glucose Clamp Technique; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D007430:Intraoperative Care / Q000379:methods*; D008099:Liver / Q000098:blood supply*; D008297:Male; D010100:Oxygen / Q000097:blood*; D011188:Potassium / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium; D010100:Oxygen