Intraoperative management of hyperglycemia in the cardiac surgical patient.
The stress response of cardiac surgery leads to hyperglycemia, and undergoing cardiopulmonary bypass magnifies this response greatly. Counter-regulatory hormones, the cytokine response, and the automatic nervous system are all part of the coordinated host response that can lead to hyperglycemia. Postoperative hyperglycemia is associated with worsened perioperative outcomes, and there are data demonstrating this to also be true for the intraoperative period. Many factors affect intraoperative glucose control, including cardiopulmonary pump (CPB) prime fluid composition, temperature while on CPB, and medications such as catecholamines and glucocorticoids. Intraoperative glucose control has a significant impact on postoperative outcomes. No optimal intraoperative insulin regimen has been identified, but continuous intravenous infusions appear to be superior to intermittent sliding scale dosing. In addition, the technique of hyperinsulinemic glucose clamp shows the greatest promise of achieving normoglycemia while on CPB.
Rassias
Athos J
AJ
Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03755, USA. athos.rassias@hitchcock.org
D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002490:Central Nervous System / Q000378:metabolism / Q000503:physiopathology; D006331:Heart Diseases / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D007432:Intraoperative Period; D010587:Phagocytosis; D016897:Respiratory Burst; D013312:Stress, Physiological / Q000150:complications / Q000378:metabolism / Q000503:physiopathology
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin