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J Thorac Cardiovasc Surg 1997;113:354-362
© 1997 Mosby, Inc.
CARDIAC AND PULMONARY REPLACEMENT |
Received for publication July 3, 1996. revisions requested August 26, 1996; revisions received Sept. 23, 1996 accepted for publication Sept. 24, 1996. Address for reprints: Harold L. Lazar, MD, Department of Cardiothoracic Surgery, Suite B404, The Boston University Medical Center Hospital, 88 E. Newton St., Boston, MA 02118.
Abstract
Objective: This prospective, randomized, clinical study was undertaken to determine whether glucose-insulin-potassium solutions would benefit patients undergoing coronary artery bypass grafting because of unstable angina.Methods: The study group consisted of 30 patients with unstable angina who required coronary artery bypass grafting. In 15 patients, glucose-insulin-potassium solution (30% dextrose in water; K+, 80 mEq/L; regular insulin, 50 units) was given intravenously at 1 ml/kg per hour after induction of anesthesia and administration continued for 12 hours after aortic unclamping. Fifteen patients in a separate group received 5% dextrose in water intravenously at 50 ml/hr.Results: Patients treated with glucose-insulin-potassium solution had higher cardiac indices (2.8 ± 0.1 vs 2.0 ± 1 L/min per square meter; p < 0.001), lower inotrope scores (0.06 ± 0.01 vs 0.46 ± 0.19; p = 0.041), and less weight gain (6.4 ± 9 vs 11.6 ± 1.1 pounds; p < 0.001) and had shorter times of ventilator support (8.3 ± 0.6 vs 14.2 ± 0.2 hours; p = 0.003). They had a significantly lower incidence of atrial fibrillation (13.3% vs 53.3%; p = 0.020) and had shorter stays in the intensive care unit (14.8 ± 1.3 vs 31.6 ± 5.2 hours; p = 0.002) and in the hospital (6.0 ± 0.4 vs 8.0 ± 0.7 days; p = 0.010).Conclusions: We conclude that glucose-insulin-potassium therapy enhances myocardial performance and results in faster recovery from urgent coronary artery bypass grafting.
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