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J Thorac Cardiovasc Surg 1997;113:354-362
© 1997 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

GLUCOSE-INSULIN-POTASSIUM SOLUTIONS ENHANCE RECOVERY AFTER URGENT CORONARY ARTERY BYPASS GRAFTING

Harold L. Lazar, MDa, George Philippides, MDb, Carmel Fitzgerald, RNc, Diane Lancaster, PhDc, Richard J. Shemin, MDa, Carl Apstein, MDb

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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