Metabolic changes after cardiac surgery

Jakob, Stephan M.; Ensinger, H.; Takala, Jukka

doi:10.1097/00075197-200103000-00012

Cited by 38 publications

(27 citation statements)

References 60 publications

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“…During CPB, adverse effects triggered by acetate exposure would be difficult to detect amongst the vigorous metabolic and host defence responses to surgery [18,27], hypothermia, and non-pulsatile blood flow [1]. Although there is no proven detrimental effect, the concentrations documented in this report suggest a need for further investigations into the safety of acetate containing fluids during CPB.…”

Section: Discussionmentioning

confidence: 97%

Plasma acetate, gluconate and interleukin-6 profiles during and after cardiopulmonary bypass: a comparison of Plasma-Lyte 148 with a bicarbonate-balanced solution

et al. 2011

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IntroductionAs even small concentrations of acetate in the plasma result in pro-inflammatory and cardiotoxic effects, it has been removed from renal replacement fluids. However, Plasma-Lyte 148 (Plasma-Lyte), an electrolyte replacement solution containing acetate plus gluconate is a common circuit prime for cardio-pulmonary bypass (CPB). No published data exist on the peak plasma acetate and gluconate concentrations resulting from the use of Plasma-Lyte 148 during CPB.MethodsThirty adult patients were systematically allocated 1:1 to CPB prime with either bicarbonate-balanced fluid (24 mmol/L bicarbonate) or Plasma-Lyte 148. Arterial blood acetate, gluconate and interleukin-6 (IL-6) levels were measured immediately before CPB (T1), three minutes after CPB commencement (T2), immediately before CPB separation (T3), and four hours post separation (T4).ResultsAcetate concentrations (normal 0.04 to 0.07 mmol/L) became markedly elevated at T2, where the Plasma-Lyte group (median 3.69, range (2.46 to 8.55)) exceeded the bicarbonate group (0.16 (0.02 to 3.49), P < 0.0005). At T3, levels had declined but the differential pattern remained apparent (Plasma-Lyte 0.35 (0.00 to 1.84) versus bicarbonate 0.17 (0.00 to 0.81)). Normal circulating acetate concentrations were not restored until T4. Similar gluconate concentration profiles and inter-group differences were seen, with a slower T3 decay. IL-6 increased across CPB, peaking at T4, with no clear difference between groups.ConclusionsUse of acetate containing prime solutions result in supraphysiological plasma concentrations of acetate. The use of acetate-free prime fluid in CPB significantly reduced but did not eliminate large acetate surges in cardiac surgical patients. Complete elimination of acetate surges would require the use of acetate free bolus fluids and cardioplegia solutions.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000267055

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Section: Discussionmentioning

confidence: 97%

Plasma acetate, gluconate and interleukin-6 profiles during and after cardiopulmonary bypass: a comparison of Plasma-Lyte 148 with a bicarbonate-balanced solution

et al. 2011

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“…Undergoing cardiac surgery with cardiopulmonary bypass (CPB) increases the risk of developing hyperglycemia [3,4] because of the associated hyperoxia and hypothermia and increased inflammatory response induced by contact of blood with foreign material in the CPB system [5-7]. In addition, intra-operative glucose infusion contributes to hyperglycemia in children undergoing cardiac surgery [8].…”

Section: Introductionmentioning

confidence: 99%

Does a reduced glucose intake prevent hyperglycemia in children early after cardiac surgery? a randomized controlled crossover study

et al. 2012

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IntroductionHyperglycemia in children after cardiac surgery can be treated with intensive insulin therapy, but hypoglycemia is a potential serious side effect. The aim of this study was to investigate the effects of reducing glucose intake below standard intakes to prevent hyperglycemia, on blood glucose concentrations, glucose kinetics and protein catabolism in children after cardiac surgery with cardiopulmonary bypass (CPB).MethodsSubjects received a 4-hour low glucose (LG; 2.5 mg/kg per minute) and a 4-hour standard glucose (SG; 5.0 mg/kg per minute) infusion in a randomized blinded crossover setting. Simultaneously, an 8-hour stable isotope tracer protocol was conducted to determine glucose and leucine kinetics. Data are presented as mean ± SD or median (IQR); comparison was made by paired samples t test.ResultsEleven subjects (age 5.1 (20.2) months) were studied 9.5 ± 1.9 hours post-cardiac surgery. Blood glucose concentrations were lower during LG than SG (LG 7.3 ± 0.7 vs. SG 9.3 ± 1.8 mmol/L; P < 0.01), although the glycemic target (4.0-6.0 mmol/L) was not achieved. No hypoglycemic events occurred. Endogenous glucose production was higher during LG than SG (LG 2.9 ± 0.8 vs. SG 1.5 ± 1.1 mg/kg per minute; P = 0.02), due to increased glycogenolysis (LG 1.0 ± 0.6 vs. SG 0.0 ± 1.0 mg/kg per minute; P < 0.05). Leucine balance, indicating protein balance, was negative but not affected by glucose intake (LG -54.8 ± 14.6 vs. SG -58.8 ± 16.7 μmol/kg per hour; P = 0.57).ConclusionsCurrently recommended glucose intakes aggravated hyperglycemia in children early after cardiac surgery with CPB. Reduced glucose intake decreased blood glucose concentrations without causing hypoglycemia or affecting protein catabolism, but increased glycogenolysis.Trial registrationDutch trial register NTR2079.

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“…Geniş hasta grupları ile yapılan çalışmalarda, hiperlaktatemi ile ilişkili en sık nedenin KPB süresi olduğu gösterilmiş-tir [1,5,6,13] . Bunun yanı sıra acil olgu olması, revizyon cerrahisi, düşük hemoglobin, renal yetmezlik olması, ejeksiyon fraksiyonu (EF) düşüklüğü ve diabetes mellitus nedenler arasında bulunmaktadır [10][11][12] .Yaş ile ilişkili olduğunu belirten çalışmalar olduğu gibi olmadığını söyleyen araştırmalar da mevcuttur [5,11] .…”

Section: Discussionunclassified

Relationship Between Lactate Levels And Complications In Coronary Artery Bypass Grafting Surgery

Gülşan¹,

Şahutoğlu²,

Kocabas³

et al. 2018

GKDA Derg

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closure, 0th, 6th, 12th, and 24th hours, (p<0.001). There were no differences in complications and mortality rates among the groups excepting multiorgan failure (MOF, p=0.027). Conclusion:In patients undergoing coronary artery surgery lactate levels may increase intraoperatively and postoperatively and reach the highest value at 12 hours postoperatively. However, apart from MOF, there was no significant relationship between high lactate levels and complications.

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Metabolic changes after cardiac surgery

Cited by 38 publications

References 60 publications

Plasma acetate, gluconate and interleukin-6 profiles during and after cardiopulmonary bypass: a comparison of Plasma-Lyte 148 with a bicarbonate-balanced solution

Plasma acetate, gluconate and interleukin-6 profiles during and after cardiopulmonary bypass: a comparison of Plasma-Lyte 148 with a bicarbonate-balanced solution

Does a reduced glucose intake prevent hyperglycemia in children early after cardiac surgery? a randomized controlled crossover study

Relationship Between Lactate Levels And Complications In Coronary Artery Bypass Grafting Surgery

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