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Canadian Journal of Anesthesia 51:A54 (2004)
© Canadian Anesthesiologists' Society, 2004

Abstracts - Tuesday June 22nd 2004 0800-1000

GLUCOSE, INSULIN, AND POTASSIUM (GIK) IN CORONARY ARTERY SURGERY

Cantwell Clark, MD, Reed D Quinn, MD, John H Braxton, MD, Andreas H Taenzer, MD and Kristen M Sullivan, BA

Departments of Anesthesiology and Cardiac Surgery, Maine Medical Center, Bramhall St., Portland, Maine, USA, 04102

INTRODUCTION: While there have been many positive studies of GIK in the setting of acute myocardial infarction and a number of positive studies of GIK in the setting of heart failure during cardiac surgery (#1), GIK has not been widely used as therapy in perioperative heart failure. We used a risk score from the Northern New England Cardiovascular Disease Study Group (NNE) (#2) to select a group of patients prospectively at high risk for perioperative low output failure during coronary artery bypass grafting (CABG), and then randomized them to receive GIK or routine therapy.

METHODS: After institutional review board approval, we randomized 228 CABG patients with NNE scores in the 10% at greatest risk for perioperative low output failure (LOF) to either a GIK group or a control group. The GIK group received GIK (1000 ml dextrose 25% with 100units regular insulin and 100 meq of KCL) at 1ml/kg/hour in the operating room and 0.33ml/kg/hour for a total of 24 hours. Therapy was otherwise the same for both groups. LOF was defined as two or more inotropes at 48 hours post-op.

RESULTS: There were no differences between the two groups in terms of age, gender, weight, diabetes, peripheral vascular disease, renal failure, pre-operative ejection fraction, number of bypass grafts, and NNE risk score. Outcomes are summarized in table 1Go.


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  		TABLE 1 (Continuous data reported as mean +/– standard deviation.)
 
DISCUSSION: The first cardiac output after CPB was marginally higher in the GIK group with a p = 0.03. All other outcomes were similar for both groups. While others have shown some benefit to GIK in certain cardiac surgical patients, we demonstrated no clinical value in a subset of patients prospectively identified as at high risk for peri-operative LOF. GIK cannot be recommended for routine use even in a high-risk cardiac surgical population.

REFERENCES:

1 Ann Thorac Surg 2003;75:S721–8.[Abstract/Free Full Text]

2 Anesth Analg 2001;92(3):596–601.[Abstract/Free Full Text]





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