title: Glucose and insulin administration while maintaining normoglycemia during cardiac surgery using a computer-assisted algorithm.
abstract: BACKGROUND
  applying the principles of the hyperinsulinemic-normoglycemic clamp technique we have introduced glucose and insulin administration while maintaining normoglycemia (GIN therapy) to surgical patients. The objective of this study was to evaluate a novel computer software (GIN Computer Software [GINCS]) program using an algorithm based on the original clamp equation and modified for its use during cardiac surgery.
  
  
  METHODS
  thirty-six patients without diabetes undergoing elective cardiac surgery were randomly assigned to manually controlled or computer-guided GIN therapy. In both groups insulin was administered at 5 mU/kg/min during surgery. Simultaneously, 20% dextrose was infused at a rate adjusted to maintain blood glucose (BG) between 4.0 and 6.0 mmol/L. The adjustments were made either following an algorithm based on our previous GIN experience or suggestions made by the software program. The primary outcome was the achievement of target glycemia.
  
  
  RESULTS
  normoglycemia was achieved in both groups as reflected by mean BG concentrations of 5.0 ± 0.5 mmol/L and 5.1 ± 0.2 mmol/L. Mean sampling intervals were longer in the GINCS group than in the manual group (21.5  ± 1.9 vs. 14.2 ± 2.2 min, P < 0.001). The GINCS therapy was associated with a greater percentage of BG measurements within target (manual group, before cardiopulmonary bypass [CPB] 79.7%, during CPB 68.1%, and after CPB 69.1%; GINCS group, before CPB 94.1%, during CPB 92.4%, and after CPB 97.7%; P < 0.001). No hypoglycemia was observed.
  
  
  CONCLUSIONS
  the use of a computer-guided GIN protocol in patients without diabetes undergoing open heart surgery provided excellent and safe glycemic control.
authors.affiliation: Department of Anaesthesia, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Tamaki
authors.initials: T
authors.lastname: Sato
authors.forename: George
authors.initials: G
authors.lastname: Carvalho
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sato
authors.forename: Ralph
authors.initials: R
authors.lastname: Lattermann
authors.forename: Thomas
authors.initials: T
authors.lastname: Schricker
mesh_terms: D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012984:Software
chemical_list: D001786:Blood Glucose; D007328:Insulin; D005947:Glucose