title: Medanta insulin protocols in patients undergoing cardiac surgery.
abstract: Hyperglycemia is common in patients undergoing cardiac surgery and is associated with poor outcomes. This is a review of the perioperative insulin protocol being used at Medanta, the Medicity, which has a large volume cardiac surgery setup. Preoperatively, patients are usually continued on their preoperative outpatient medications. Intravenous insulin infusion is intiated postoperatively and titrated using a column method with a choice of 7 scales. Insulin dose is calculated as a factor of blood glucose and patient's estimated insulin sensitivity. A comparison of this protocol is presented with other commonly used protocols. Since arterial blood gas analysis is done every 4 hours for first two days after cardiac surgery, automatic data collection from blood gas analyzer to a central database enables collection of glucose data and generating glucometrics. Data auditing has helped in improving performance through protocol modification.
authors.affiliation: Senior Consultant, Division of Endocrinology and Diabetes, Medanta, The Medicity, Gurgaon, Haryana, India.
authors.forename: Beena
authors.initials: B
authors.lastname: Bansal
authors.affiliation: Chairman, Division of Endocrinology and Diabetes, Medanta, The Medicity, Gurgaon, Haryana, India.
authors.forename: Ambrish
authors.initials: A
authors.lastname: Mithal
authors.affiliation: Scientist, Gida Technology Services, Bangalore, Karnataka, India.
authors.forename: Pravin
authors.initials: P
authors.lastname: Carvalho
authors.affiliation: Chairman, Institute of Critical Care and Anaesthesiology, Medanta, The Medicity, Gurgaon, Haryana, India.
authors.forename: Yatin
authors.initials: Y
authors.lastname: Mehta
authors.affiliation: Chairman, Heart Institute-Division of Cardiothoracic and Vascular Surgery, Medanta, The Medicity, Gurgaon, Haryana, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Trehan
keywords: Cardiac surgery; infusion; insulin; protocol