The influence of glucose-insulin-potassium (GIK) on the GH/IGF-1/IGFBP-1 axis during elective coronary artery bypass surgery.
OBJECTIVE
To investigate the influence of glucose-insulin-potassium (GIK) on the growth hormone/insulin-like growth factor-1 axis.


METHODS
Randomized clinical study.


METHODS
University hospital.


METHODS
Twenty patients, without metabolic disorders, admitted for elective aortocoronary bypass surgery.


METHODS
GIK therapy. Measurements and main results Blood samples were taken repeatedly during the day of surgery. Ejection fraction (EF) was determined by transesophageal echocardiography before and at the end of surgery. Blood samples were taken on the first postoperative day and at discharge (8 am and 8 pm). During coronary artery bypass graft (CABG) surgery, a rapid decrease (44%) in total IGF-1 occurred in both groups. Directly after cessation of extracorporeal circulation, there was a prompt rise in IGFBP-1. The mean peak value in the control group was more than 3 times higher than in the GIK group. GH secretion was stimulated by surgery in both groups and was enhanced by GIK. B-glucose was significantly higher in the control group during surgery. EF ( approximately 55% at baseline) was unchanged in both groups. Postoperatively, there were no differences between the groups (all parameters). At discharge, IGFBP-1 was unchanged, but insulin was elevated compared with preoperative levels. This was seen in both groups, reflecting a hepatic insulin resistance. Conclusions The authors conclude that GIK blunts the rise of IGFBP-1 and thereby increases the bioavailability of IGF-1. GIK also seems to speed up the return of IGF-1 to baseline. Both mechanisms could be of importance to catabolic high-risk patients with low IGF-1. Hence, GIK has favorable effects on the GH/IGF-1 axis during CABG surgery.
Wallin
Mats
M
Department of Anesthesiology and Intensive Care, Karolinska Hospital, Stockholm, Sweden. mats.wallin@labtek.ki.se
Barr
Gunilla
G
öWall
Anders
A
Lindahl
Sten G e
SG
Brismar
Kerstin
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001806:Blood Urea Nitrogen; D001026:Coronary Artery Bypass; D005112:Extracorporeal Circulation; D005260:Female; D005947:Glucose / Q000627:therapeutic use*; D013006:Growth Hormone / Q000187:drug effects* / Q000378:metabolism; D006454:Hemoglobins / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D018969:Insulin-Like Growth Factor Binding Proteins / Q000187:drug effects* / Q000378:metabolism; D007334:Insulin-Like Growth Factor I / Q000187:drug effects* / Q000378:metabolism; D007362:Intensive Care Units; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000627:therapeutic use*; D013223:Statistics as Topic; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D006454:Hemoglobins; D007328:Insulin; D018969:Insulin-Like Growth Factor Binding Proteins; C030396:glucose-insulin-potassium cardioplegic solution; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D005947:Glucose; D011188:Potassium