Intensive insulin therapy during cardiovascular surgery.
Recent evidence in the fields of surgery, emergency and critical care medicine indicates that strict glycemic control results in lower mortality. Hyperglycemia occurs frequently in patients with and without diabetes during cardiovascular surgery, especially during cardiopulmonary bypass. However, strict glucose control is difficult to achieve during cardiovascular procedures. To establish effective intensive insulin therapy during cardiovascular surgery, we conduct continuous blood glucose monitoring and employ automatic control by using an artificial endocrine pancreas (the STG-22, Nikkiso, Tokyo, Japan). In this review, we will outline the present status and problems of conventional glycemic control for perioperative cardiovascular surgery and introduce the new perioperative blood glucose management method that we are testing now. We will also discuss the importance of perioperative glycemic control for cardiovascular surgery as well as future prospects.
Kawahito
Shinji
S
Department of Anesthesiology, Tokushima University Hospital, Tokushima, Japan.
Kitahata
Hiroshi
H
Kitagawa
Tetsuya
T
Oshita
Shuzo
S
D001786:Blood Glucose / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D003422:Critical Care; D048909:Diabetes Complications / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007564:Japan; D016343:Monitoring, Intraoperative; D019397:Pancreas, Artificial; D016032:Randomized Controlled Trials as Topic
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin