Perioperative tight glucose control with hyperinsulinemic-normoglycemic clamp technique in cardiac surgery.
OBJECTIVE
Previous attempts to achieve tight glucose control in surgical patients were associated with a significant incidence of hypoglycemia. The purpose of this study was to evaluate the efficacy of perioperative glucose and insulin administration while maintaining normoglycemia using a hyperinsulinemic-normoglycemic clamp technique.


METHODS
We studied 70 non-diabetic and 40 diabetic patients undergoing cardiac procedures. Before induction of anesthesia, insulin was administered at 5 mU·kg(-1)·min(-1). Blood glucose (BG) concentrations were determined every 15-30 min. Dextrose 20% was infused at a rate adjusted to maintain BG within 3.5-6.1 mmol/L. At the end of surgery, insulin infusion was decreased to 1 mU·kg(-1)·min(-1) and continued for 24h. The mean ± standard deviation of BG and the percentage of BG values within the target range were calculated perioperatively. Episodes of severe hypoglycemia, i.e., BG <2.2 mmol/L, were recorded.


RESULTS
The mean BG remained within target at all times. Normoglycemia in non-diabetic patients was achieved in 92.8% of measurements during and in 83.2% after surgery. In diabetic patients 87.4% of values were within target intraoperatively and 76.7% after surgery. The rate of severe hypoglycemia was 2.7% (three patients). In non-diabetic patients the incidence of severe hypoglycemia was 0.2% of measurements during and 0.1% after surgery. Diabetic patients showed only one episode of severe hypoglycemia after surgery (0.1%).


CONCLUSIONS
Perioperative use of a hyperinsulinemic-normoglycemic clamp technique established and maintained normoglycemia in patients undergoing cardiac surgery with little risk of hypoglycemia.
Sato
Hiroaki
H
Department of Anaesthesia, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada.
Carvalho
George
G
Sato
Tamaki
T
Bracco
David
D
Codere-Maruyama
Takumi
T
Lattermann
Ralph
R
Hatzakorzian
Roupen
R
Matsukawa
Takashi
T
Schricker
Thomas
T
D000368:Aged; D001786:Blood Glucose; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000601:surgery*; D058065:Diabetic Cardiomyopathies / Q000097:blood / Q000601:surgery*; D005260:Female; D015309:Glucose Clamp Technique / Q000009:adverse effects; D006349:Heart Valve Diseases / Q000097:blood / Q000150:complications / Q000601:surgery*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000453:epidemiology / Q000517:prevention & control; D015994:Incidence; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects / Q000379:methods*; D011184:Postoperative Period
D001786:Blood Glucose