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Ann Thorac Surg 2000;70:145-150
© 2000 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery, Boston Medical Center and Boston University School of Medicine, Boston, Massachussetts, USA
b Division of Endocrinology, Boston Medical Center and Boston University School of Medicine, Boston, Massachussetts, USA
c Division of Cardiology, Boston Medical Center and Boston University School of Medicine, Boston, Massachussetts, USA
Address reprint requests to Dr Lazar, Department of Cardiothoracic Surgery, Boston Medical Center, Suite B404, 88 East Newton St, Boston, MA 02118
Background. This study was undertaken to determine whether glucose-insulin-potassium (GIK) would improve myocardial performance and limit morbidity after coronary artery bypass grafting in diabetic patients.
Methods. Forty consecutive coronary artery bypass grafting patients with medically treated diabetes mellitus were prospectively randomly assigned to either a GIK group (n = 20; 500 mL D5W + 80 U regular insulin + 40 mEq KCl 30 mL/hour) or a no-GIK group (n = 20; D5W at 30 mL/hour). The GIK was begun at anesthetic induction and continued for 12 hours postoperatively.
Results. Patients treated with GIK had higher postoperative cardiac indices (2.88 ± 0.50 versus 2.20 ± 0.39 L/minute per square meter; p < 0.0001), lower inotrope scores (0.40 ± 0.68 versus 1.25 ± 1.44; p = 0.05), less weight gain (5.80 ± 3.76 versus 13.85 ± 6.52 pounds; p < 0.0001), and had shorter times of ventilator support (8.35 ± 2.60 versus 13.45 ± 7.33 hours; p = 0.0128). They had a significantly lower prevalence of atrial fibrillation (15% versus 60%; p = 0.003), and shorter hospital stays (6.70 ± 1.52 versus 10.15 ± 6.62 days; p = 0.02).
Conclusions. Substrate enhancement with GIK in diabetic patients improved myocardial performance and resulted in faster recovery after coronary artery bypass grafting.
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