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Canadian Journal of Anesthesia 50:A94 (2003)
© Canadian Anesthesiologists' Society, 2003

Abstracts - Tuesday June 24th 2003 1030 - 1230

MAINTAINING NORMOGLYCEMIA DURING CARDIAC SURGERY

George Carvalho, MD1, Anne Moore, MD1, Kevin Lachapelle, MD2, Baqir Quizilbash, MD1 and Thomas Schricker, MD PhD1

1 Department of Anesthesia,
2 Department of Cardiac Surgery, McGill University, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1

INTRODUCTION

Hyperglycemia during cardiac procedures is severe with glucose levels often exceeding 15 mmol•L-1 (1). Most recent attempts to maintain intraoperative normoglycemia failed despite the use of high doses of insulin (2,3). We used the hyperinsulinemic normoglycemic clamp technique, i.e. infusion of insulin at a constant rate combined with glucose titrated to "clamp" blood glucose at a specific level, to preserve normoglycemia during cardiac surgery.

METHODS

We studied five non-diabetic and three diabetic patients undergoing coronary artery bypass grafting at the Royal Victoria Hospital. Anesthetic and surgical treatment was performed according to the standards established in our institution. Cardioplegia was free of glucose. Blood glucose was measured before induction of anesthesia, and a priming bolus of insulin (2U) was followed by insulin infusion of 5mU•kg-1•min-1. Additional insulin boluses were given if the blood glucose remained >6.0mmol•L-1. Ten minutes after commencing the insulin infusion or when the blood glucose was <6.0mmol•L-1, variable amounts of dextrose 20% were administered. Arterial blood glucose was measured every 5 min with the Accu-chek glucose monitor (Roche Diagnostics, Switzerland). Successful control of normoglycemia was defined as >=90% of the glucose levels within the target range (4.0-6.0mmol•L-1).

RESULTS

Normoglycemia was achieved in all patients. Before CPB one patient in the non-diabetic group received an additional bolus of 2U, while all three diabetic patients required insulin boluses of 6U, 8U, and 68U, respectively.

DISCUSSION

Normal blood glucose concentrations during open heart surgery were maintained in a reliable fashion by using the hyperinsulinemic normoglycemic clamp technique. As expected, diabetic patients required less glucose to preserve normoglycemia than non-diabetic patients.


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REFERENCES

1 Clin Intensive Care 1998; 9: 118–28

2 Anesth Analg 1999; 89: 1091–5[Abstract/Free Full Text]

3 Anesth Analg 2002; 94: 1113–9[Abstract/Free Full Text]





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