Intravenous glucose-insulin-potassium during off-pump coronary artery bypass surgery does not reduce myocardial injury.
BACKGROUND
This randomized, double-blind, placebo-controlled study was designed to determine whether an intra-operative, intravenous infusion of glucose-insulin-potassium (GIK) could be helpful in the prevention of myocardial ischemia and in the maintenance of intra-operative cardiac performance in patients undergoing off-pump coronary artery bypass (OP-CAB) surgery.


METHODS
Eighty two adults undergoing elective OP-CAB surgery were randomly divided into two groups that received intravenously either 5% dextrose in water or GIK (50% dextrose in 500 ml of water; regular insulin, 125 IU; potassium, 80 mmol) at 0.75 ml/kg/h immediately before the induction of anesthesia to the end of surgery. To evaluate myocardial damage, creatine kinase MB and troponin T were measured before surgery, immediately after arrival in the intensive care unit and on the first post-operative day. To assess cardiac performance, hemodynamic data were obtained before and after the induction of anesthesia, before and after the bypass graft and after sternal closure. Blood glucose was measured at the same time.


RESULTS
There was no significant difference in cardiac enzymes, hemodynamic parameters and blood glucose between the two groups. The use of vasoactive, inotropic and/or anti-arrhythmic agents, insulin and supplemental glucose was not significantly different between the groups.


CONCLUSIONS
The results suggest that the intravenous administration of GIK during OP-CAB surgery neither reduces myocardial damage nor improves intra-operative cardiac performance in patients without contractile dysfunction.
Shim
Y H
YH
Department of Anesthesiology & Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Kweon
T D
TD
Lee
J H
JH
Nam
S B
SB
Kwak
Y L
YL
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D047549:Coronary Artery Bypass, Off-Pump; D052279:Creatine Kinase, MB Form / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006321:Heart / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000517:prevention & control*; D011188:Potassium / Q000008:administration & dosage; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood
D001786:Blood Glucose; D002314:Cardioplegic Solutions; D007328:Insulin; D020107:Troponin T; C030396:glucose-insulin-potassium cardioplegic solution; D052279:Creatine Kinase, MB Form; D005947:Glucose; D011188:Potassium