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Ann Thorac Surg 2002;73:1246-1251
© 2002 The Society of Thoracic Surgeons
a Departments of Anesthesiology St, Birmingham, AL, USA
b Surgery, The University of Alabama at Birmingham St, Birmingham, AL, USA
c Kemp Carraway Heart Institute, Birmingham, Alabama, USA
Accepted for publication December 16, 2001.
* Address reprint requests to Dr Lell, Department of Anesthesiology, The University of Alabama at Birmingham, 619 South 19th St, Birmingham, AL 35249-6810 USA
e-mail: william.lell{at}ccc.uab.edu
Background. The purpose of this randomized, double-blind, placebo-controlled pilot study was to determine the effectiveness of an intravenous glucose-insulin-potassium (GIK) infusion in preventing myocardial damage and maintaining cardiac performance in patients undergoing "off-pump" myocardial revascularization.
Methods. Forty-six adult patients undergoing elective off-pump coronary artery bypass received either normal saline or a GIK infusion immediately after the induction of anesthesia through the first 12 hours of intensive care unit convalescence. Measurements of blood glucose, circulating creatine kinase MB and troponin I concentrations, as well as cardiac index (CI) and mixed venous oxygen saturation (SVO2), were obtained immediately before starting the infusion (baseline) and at 6,12, and 24 hours post–initial coronary artery occlusion.
Results. Five patients (8%) requiring cardiopulmonary bypass were excluded from data analysis. Twenty patients received saline. Twenty-one received GIK. Blood glucose was significantly higher in the GIK group. The concentration of circulating creatine kinase MB and troponin I significantly increased over time after off-pump coronary artery bypass, with no significant intergroup differences. Cardiac index and SVO2 did not differ significantly between groups.
Conclusions. A GIK infusion protocol commonly used as an adjunct to reperfusion therapy for acute myocardial infarction causes insulin-resistant hyperglycemia in elective off-pump coronary artery bypass patients with no demonstrable benefit. The finding of significant release of cardio-specific enzymes in individual patients implies an ongoing need to develop more effective strategies for myocardial protection during off-pump coronary artery bypass.
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