Improved myocardial protection during coronary artery surgery with glucose-insulin-potassium: A randomized controlled trial

Quinn, David W.; Pagano, Domenico; Bonser, Robert S.; Rooney, Stephen J.; Graham, Timothy R.; Wilson, Ian C.; Keogh, Bruce; Townend, Jonathan N.; Lewis, Michael

doi:10.1016/j.jtcvs.2005.05.057

Cited by 67 publications

(56 citation statements)

References 30 publications

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“…Initially 280 patients were randomized (1:1) to receive either placebo or GIK therapy (placebo nϭ142 and GIK nϭ138). 1 After an interim safety analysis on the first 80 patients, the second study was powered to investigate the hemodynamic effects of placebo, GIK, T3, and combined GIK/T3 therapy (n ϭ160; placebo, nϭ18; GIK, nϭ19; T3, nϭ63; GIK/T3, nϭ60). The second study was performed with continuous randomization schedules (1:1:3:3) and identical trial protocols.…”

Section: Methodsmentioning

confidence: 99%

“…1 Anesthesia was induced using intravenous etomidate, fentanyl, and pancuronium and maintained with enflurane, propofol, and alfentanil. Intermittent antegrade cold blood St. Thomas No.…”

Section: Surgery Anesthesia Cardiopulmonary Bypass and Myocardial Pmentioning

confidence: 99%

“…Perioperative GIK therapy has been used to improve the efficiency of energy utilization, hemodynamic performance, and outcomes in patients undergoing cardiac surgery. 1,2 Experimental models have demonstrated a direct positive inotropic effect of insulin on postischemic hearts independent of its metabolic effects as well as reducing apoptotic injury to the myocardium when administered at reperfusion. [3][4][5] Patients undergoing cardiac surgery may develop the euthyroid sick syndrome (ESS).…”

mentioning

confidence: 99%

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Glucose-Insulin-Potassium and Tri-Iodothyronine Individually Improve Hemodynamic Performance and Are Associated With Reduced Troponin I Release After On-Pump Coronary Artery Bypass Grafting

et al. 2006

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Background— Both glucose-insulin-potassium (GIK) and tri-iodothyronine (T3) may improve cardiovascular performance after coronary artery surgery (CABG) but their effects have not been directly compared and the effects of combined treatment are unknown. Methods and Results— In 2 consecutive randomized double-blind placebo-controlled trials, in patients undergoing first time isolated on-pump CABG between January 2000 and September 2004, 440 patients were recruited and randomized to either placebo (5% dextrose) (n=160), GIK (40% dextrose, K + 100 mmol · L −1 , insulin 70 u · L −1 ) (0.75 mL · kg −1 h −1 ) (n=157), T3 (0.8 μg · kg −1 followed by 0.113 μg · kg −1 h −1 ) (n=63) or GIK+T3 (n=60). GIK/placebo therapy was administered from start of operation until 6 hours after removal of aortic cross-clamp (AXC) and T3/placebo was administered for a 6-hour period from removal of AXC. Serial hemodynamic measurements were taken up to 12 hours after removal of AXC and troponin I (cTnI) levels were assayed to 72 hours. Cardiac index (CI) was significantly increased in both the GIK and GIK/T3 group in the first 6 hours compared with placebo ( P <0.001 for both) and T3 therapy ( P =0.009 and 0.029, respectively). T3 therapy increased CI versus placebo between 6 and 12 hours after AXC removal ( P =0.01) but combination therapy did not. Release of cTnI was lower in all treatment groups at 6 and 12 hours after removal of AXC. Conclusions— Treatment with GIK, T3, and GIK/T3 improves hemodynamic performance and results in reduced cTnI release in patients undergoing on-pump CABG surgery. Combination therapy does not provide added hemodynamic effect.

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Section: Methodsmentioning

confidence: 99%

“…1 Anesthesia was induced using intravenous etomidate, fentanyl, and pancuronium and maintained with enflurane, propofol, and alfentanil. Intermittent antegrade cold blood St. Thomas No.…”

Section: Surgery Anesthesia Cardiopulmonary Bypass and Myocardial Pmentioning

confidence: 99%

mentioning

confidence: 99%

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Glucose-Insulin-Potassium and Tri-Iodothyronine Individually Improve Hemodynamic Performance and Are Associated With Reduced Troponin I Release After On-Pump Coronary Artery Bypass Grafting

et al. 2006

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“…[4] Quinn ve ark. [13] diyabetik olmayan KABG hastalarında GİK tedavisi sonrası hastalarda miyokardiyal fonksiyonun daha iyi olduğunu, düşük debi durumunun insidansının azaldığı-nı ve miyokardiyal hasarın azaldığını tespit etmişlerdir.…”

Section: Discussionunclassified

The effect of high-dose GIK infusion on cytokin levels in beating heart coronary artery bypass graft surgery patients with left ventricular dysfunction

Yağar¹

2012

Turk Gogus Kalp Dama

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Amaç: Bu çalışmada; atan kalpte koroner arter baypas greft (KABG) cerrahisi uygulanacak sol ventrikül fonksiyonu bozuk olan koroner arter hastalarında yüksek doz insülinin sitokin düzeyleri (interlökin [IL]-6, IL-10 ve tümör nekroz faktör-alfa [TNF-a]), kardiyak biyobelirteçler (CK-MB, cTnI, AST) ve erken dönem prognoza olan muhtemel etkileri araştırıldı.Ça lış ma pla nı: Çalışmaya Temmuz 2009 -Mart 2010 tarihleri arasında kliniğimizde düşük sol ventrikül ejeksiyon fraksiyonlu (EF <%50) olup, atan kalpte KABG cerrahisi yapılan 30 hasta prospektif olarak dahil edildi. Hastalar çalışma ve kontrol kolu olmak üzere iki alt gruba ayrıldı. Çalışma kolunda yer alan 18 hastaya (15 erkek, 3 kadın; ort. yaş 63.1±11 yıl; dağılım 40-79 yıl), glukoz-insulin-potasyum (GİK) infüzyonu başlanırken, kontrol kolundaki 12 hastaya (9 erkek, 3 kadın; ort. yaş 58.6±13.4 yıl; dağılım 41-79 yıl) GİK infüzyonu verilmedi. Tedavi kolundaki tüm hastalara 500 ml %20'lik dekstroz, 40 IU kristalize insülin ve 40 mEq potasyum karışımı, 1ml/kg/h hızında anestezi indüksiyonundan sonra başlandı ve 24 saat boyunca infüzyona devam edildi. CK-MB, AST, cTnI, IL-6, IL-10 ve TNF-a düzey-leri (i) anestezi indüksiyonu öncesi, (ii) ameliyat bitiminde ve (iii) yoğun bakım ünitesinde (YBÜ) kalışın 24. saatinde kan alı-narak ölçüldü. Ameliyat sırasında ve ameliyat sonrası 24 saatlik dönemde inotropik, vazodilatör ilaç infüzyonu, intraaortik balon pompa kullanımı, hastaların YBÜ'de ve hastanede kalış süreleri kaydedildi.Bul gu lar: İnterlökin-6, IL-10 ve TNF-a düzeyleri GİK grubundaki hastalarda kontrol grubundaki hastalara benzer olarak bulundu. Ameliyat sırasında ve YBÜ'deki inotropik ilaç infüz-yonları, YBÜ'de kalış süreleri iki grupta benzerdi.So nuç: Bizim çalışmamızda GİK infüzyonunun sol ventrikül fonksiyonu bozuk atan kalpte KABG uygulanan hastalarda koruyucu bir etkisi olmadığı ortaya konuldu. Bu çalışmada yüksek doz insülinin antiinflamatuvar etkisi de gözlenmedi. Ancak bu hasta grubunda insülinin sitokin düzeyleri üzerindeki etkisine ilişkin kesin sonuçlar elde etmek için, yüksek doz insülin ile yapılan geniş kapsamlı çalışmalara gereksinim olduğu görüşündeyiz.Anah tar söz cük ler: Koroner arter baypas greft cerrahisi; glukoz-insulinpotasyum; interlökin 10; interlökin 6; TNF-alfa.Background:In this study, we aimed to investigate the possible effects of high-dose insulin on cytokine levels (interleukin [IL]-6, IL-10 and tumor necrosis factor-alpha [TNF-a]), cardiac biomarkers (CK-MB, cTnI, AST) and the early-stage prognosis in patients with left ventricular dysfunction who underwent beating heart coronary artery bypass graft (CABG) surgery.

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“…Çalışmamız klinik bulgu ve komplikasyonları kapsamamaktadır, ancak benzer bir çalışmada postoperatif 4. st.'de ölçülen troponin dü-zeylerinin yüksek doz insülin infüzyonu uygulanan grupta standart gruba oranla önemli derecede düşük olduğu ve vazopressör gereksiniminin de daha az olduğu saptanmıştır (15) . Ayrıca sıkı glisemik kontrolün KABG'yi takiben aritmi ve kalp yetmezliği riskini azalttığı yönünde bulgular da mevcuttur (29,30) . Sonuç olarak, çalışmamızda elde ettiğimiz bulgular doğrultusunda, sıkı glisemik kontrol ile hem kan şe-kerinin kontrol altında tutulması hem de insülinin antiinflamatuvar etkisi ile birlikte inflamasyonun şiddeti azalmaktadır.…”

Section: Y25-y75unclassified

Effect of Insulin Infusion on Inflammatory Mediators in Patients Undergoing Cardiopulmonary Bypass

Özer¹,

Yapıcı²,

Eskandari³

et al. 2012

GKDA Derg

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Improved myocardial protection during coronary artery surgery with glucose-insulin-potassium: A randomized controlled trial

Abstract: Glucose-insulin-potassium therapy improves early postoperative cardiovascular performance, reduces inotrope requirement, and might reduce myocardial injury. These potential benefits are not at the expense of increased noncardiac morbidity.

Cited by 67 publications

References 30 publications

Glucose-Insulin-Potassium and Tri-Iodothyronine Individually Improve Hemodynamic Performance and Are Associated With Reduced Troponin I Release After On-Pump Coronary Artery Bypass Grafting

Glucose-Insulin-Potassium and Tri-Iodothyronine Individually Improve Hemodynamic Performance and Are Associated With Reduced Troponin I Release After On-Pump Coronary Artery Bypass Grafting

The effect of high-dose GIK infusion on cytokin levels in beating heart coronary artery bypass graft surgery patients with left ventricular dysfunction

Effect of Insulin Infusion on Inflammatory Mediators in Patients Undergoing Cardiopulmonary Bypass

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