title: High thoracic epidural analgesia decreases stress hyperglycemia and insulin need in cardiac surgery patients.
abstract: OBJECTIVE
  Assuming that high thoracic epidural analgesia (HTEA) with the sympathetic block might decrease postoperative blood glucose (BG) level and reduce the need of insulin, the aim was to evaluate the effect of HTEA on the BG level and insulin requirement in patients undergoing cardiac surgery.
  
  
  METHODS
  Forty-two low-risk patients age 65-79 years scheduled for elective coronary artery bypass grafting with or without aortic valve replacement were randomised to receive HTEA as supplement for general anaesthesia. BG and lactate were measured before and after cardiopulmonary bypass and postoperatively at least every 3 h together with administration of insulin. Postoperative pain was evaluated 30 min, 2, 4 and 6 h after extubation, and before discharge from the intensive care unit.
  
  
  RESULTS
  Overall BG levels showed great variation over time (P < 0.001). No statistically significant difference was found in perioperative BG, but postoperative lower BG levels were found in HTEA patients (P = 0.042). The number of patients not receiving insulin in postoperative period was significantly higher in HTEA group (9 vs. 2, P = 0.032). No differences were seen in lactate levels. Patients in the HTEA group had significant lower pain scores (P < 0.001).
  
  
  CONCLUSIONS
  HTEA preserves glucose metabolism better and leads to a lesser degree of 'stress hyperglycaemia' in cardiac surgery patients.
authors: Department of Anaesthesiology & Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
authors: J
authors: J
authors: Greisen
authors: D V
authors: DV
authors: Nielsen
authors: E
authors: E
authors: Sloth
authors: C-J
authors: CJ
authors: Jakobsen
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D001340:Autonomic Nerve Block / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D023381:Endpoint Determination; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D013312:Stress, Physiological / Q000502:physiology*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D019344:Lactic Acid