title: Glucosa-Insulin-Potassium (GIK) solution used with diabetic patients provides better recovery after coronary bypass operations.
abstract: BACKGROUND
  Tight blood glucose control has become a therapeutical goal for anesthetic management for patients scheduled for cardiac surgery, especially if they are diabetic patients.
  
  
  OBJECTIVE
  This study was created to confirm the benefits of intraoperative GIK solution usage during coronary bypass operation of diabetic patients.
  
  
  METHODS
  Patients with type 1 and 2 diabetes mellitus (DM) referred for coronary artery bypass grafting (CABG) were randomized to receive GIK solution (GIK--study group) in the first 24 hours intraoperatively or to receive official Clinical protocol without GIK solution (non GIK - control group). The primary clinical outcome was the cardiac index (CI) since it represents the most sensitive measure of cardiac work in the immediate postoperative period, and the secondary clinical outcomes were the glycemic control, insulin consumption, duration of mechanical ventilation (MV), potassium level and atrial fibrillation (AF) appearance.
  
  
  RESULTS
  One hundred diabetic patients, divided into two groups, were included in the study. The cardiac index did not show a significant difference, although the study group had CI with only minor variations than those of the controlled group, hence the reason we considered the study group as the more stable. The atrial fibrillation showed a difference between two groups, with 14 (28%) patients with postoperative AF in the control group compared with 3 (6%) patients with postoperative AF in the study group. As potassium values were stable in study group, we concluded that it can be one of the reasons for less postoperative AF in this group. The duration of MV showed a significant difference (0,003) between the two groups as well. In the study group the average MV time was 534,38 minutes, compared with the control group with 749,20 minutes. The average value of glucose was 11.1 mmol/l in the control group vs. 9.8 mmol/l in the study group. The study group had less insulin consumption in order to maintain target glycemia (p = 0.001). In the non GIK group average insulin consumption was 44 IJ per patient vs. 28.5 IJ in the GIK group.
  
  
  CONCLUSIONS
  Intraoperative GIK solution given to diabetic patients with CABG operation provides more stable CI, shorter time of MV, more stable values of potassium which provides normal rhythm and less AF onset, less insulin to maintain target glycemia. All the above mentioned provides more stable intraoperative hemodynamic and better recovery of diabetic
authors: Heart Center, Clinical Center of University of Sarajevo, Bosnia and Herzegovina.
authors: Slavenka
authors: S
authors: Straus
authors: Heart Center, Clinical Center of University of Sarajevo, Bosnia and Herzegovina.
authors: Vjekoslav
authors: V
authors: Gerc
authors: Heart Center, Clinical Center of University of Sarajevo, Bosnia and Herzegovina.
authors: Mirsad
authors: M
authors: Kacila
authors: Heart Center, Clinical Center of University of Sarajevo, Bosnia and Herzegovina.
authors: Custovic
authors: C
authors: Faruk
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control; D002314:Cardioplegic Solutions / Q000008:administration & dosage / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D016903:Drug Monitoring; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D007430:Intraoperative Care / Q000379:methods; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011188:Potassium / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium