title: Effect of glucose-insulin-potassium on hyperlactataemia in patients undergoing valvular heart surgery: A randomised controlled study.
abstract: BACKGROUND
  Hyperlactataemia represents oxygen imbalance in the tissues and its occurrence during cardiac surgery is associated with adverse outcomes. Glucose-insulin-potassium (GIK) infusion confers myocardial protection against ischaemia-reperfusion injury and has the potential to reduce lactate release while improving its clearance.
  
  
  OBJECTIVE
  The objective of this study is to compare the effect of GIK on the incidence of hyperlactataemia in patients undergoing valvular heart surgery.
  
  
  METHODS
  A randomised controlled study.
  
  
  METHODS
  Single university teaching hospital.
  
  
  METHODS
  One hundred and six patients scheduled for elective valvular heart surgery with at least two of the known risk factors for hyperlactataemia.
  
  
  METHODS
  Patients were randomly allocated to receive either GIK solution (insulin 0.1 IU kg(-1) h(-1) and an infusion of 30% dextrose and 80 mmol l(-1) potassium at 0.5 ml kg(-1) h(-1)) or 0.9% saline (control) throughout surgery.
  
  
  METHODS
  The primary outcome was the incidence of hyperlactataemia (lactate ≥ 4 mmol l(-1)) during the operation and until 24 h after the operation. Secondary outcomes included haemodynamic parameters, use of vasopressor or inotropic drugs, and fluid balance until 24 h postoperatively. Postoperative morbidity endpoints were also assessed.
  
  
  RESULTS
  The incidences of hyperlactataemia were similar in the groups (32/53 patients in each of the control and GIK groups, P > 0.999). There were no intergroup differences in haemodynamic parameters, use of vasopressor and inotropic drugs, or fluid balance. The incidences of postoperative morbidity endpoints were similar in both groups.
  
  
  CONCLUSIONS
  Despite its theoretical advantage, GIK did not provide beneficial effects in terms of the incidence of hyperlactataemia or outcome in patients undergoing valvular heart surgery.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier: NCT01825720.
authors.affiliation: From the Department of Anaesthesiology and Pain Medicine and Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Go Un
authors.initials: GU
authors.lastname: Roh
authors.forename: Jae Kwang
authors.initials: JK
authors.lastname: Shim
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Song
authors.forename: Hye Min
authors.initials: HM
authors.lastname: Kang
authors.forename: Young Lan
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D000368:Aged; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D065906:Hyperlactatemia / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium