Preconditioning with glucose-insulin-potassium solution and restoration of myocardial function during coronary surgery.
The administration of glucose-insulin-potassium (GIK) solution has beeen shown to exert cardioprotective and immunomodulatory properties in coronary disease. 49 patients (pts.) for coronary surgery were randomly assigned to receive high-dose GIK treatment (30% glucose, insulin 2 IU.kg(-1).l(-1) and K(+) 80 mmo/l solution; 1 ml/kg/h); low-dose GIK treatment (10% glucose, insulin 32 IU l(-1) and K(+) 80 mmol/l solution; 1 ml/kg/h) or control treatment (Ringer solution 1 ml/kg/h). Haemodynamic measurements were done for four time points: T1 - after induction of anaesthesia; T2 - after the operation; T3 - 6 h after the operation and T4 - 24 h after the operation. Significant recovery of cardiac function was evident in high-dose GIK (H-GIK) and low-dose GIK (L-GIK) groups after 24 h (cardiac index improved considerably (p = 0.0002)), with a statistically significant difference between the groups (p = 0.005). LVSWI covariated with PCWP, improved over time in group H-GIK (p = 0.0008) and between the groups (p = 0.046). Oxygen supply-consumption ratio evidently improved in the GIK groups, while inotropic drug support was used in 5.5% pts. in group H-GIK vs. 13% in group L-GIK and 31% pts. in control (C) group. Glucose-insulin treatment has a potential cardioprotective effect in coronary surgery. The effect is independent of the glucose-insulin concentration and amount.
Jovic
Miomir
M
Clinic for Anesthesia and Critical Care, Dedinje Cardiovascular Institute Belgrade, Milana Tepića 1, 11000 Belgrade, Serbia. drjovic@ikvbd.com
Gradinac
Sinisa
S
Lausevic-Vuk
Ljiljana
L
Nezic
Dusko
D
Stevanovic
Predrag
P
Milojevic
Predrag
P
Djukanovic
Bosko
B
D003327:Coronary Disease / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D005260:Female; D005947:Glucose / Q000494:pharmacology*; D006321:Heart / Q000187:drug effects / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007328:Insulin / Q000494:pharmacology*; D007432:Intraoperative Period; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D011184:Postoperative Period; D011188:Potassium / Q000494:pharmacology*; D020127:Recovery of Function / Q000187:drug effects*; D012996:Solutions; D013903:Thoracic Surgery
D007328:Insulin; D012996:Solutions; D005947:Glucose; D011188:Potassium; D010100:Oxygen