HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Anders Jeppsson Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jeppsson, A. Articles by Wernerman, J. Search for Related Content PubMed PubMed Citation Articles by Jeppsson, A. Articles by Wernerman, J.

J Thorac Cardiovasc Surg 1997;113:594-602
© 1997 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

INSULIN AND AMINO ACID INFUSION AFTER CARDIAC OPERATIONS: EFFECTS ON SYSTEMIC AND RENAL PERFUSION

Supported by grants from Sahlgrenska University Hospital, Göteborg Medical Society, The Swedish Medical Society, Nils Gunnarsson's Legacy, and Pharmacia-Upjohn, Stockholm, Sweden.

Received for publication Feb. 26, 1996; revisions requested July 9, 1996; revisions received Sept. 6, 1996; accepted for publication Oct. 23, 1996. Address for reprints: Anders Jeppsson, MD, Department of Thoracic and Cardiovascular Surgery, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.

Abstract

Objective: The purpose of this study was to answer two questions: (1) Does a mixed amino acid infusion enhance systemic and renal perfusion in the early postoperative period after heart operations? (2) Does the addition of insulin (glucose-insulin-potassium solution) provide additional effects to those of an amino acid infusion?

Methods: Thirty-three male patients undergoing coronary artery bypass grafting (mean age 65.9 ± 1.2 years) were included in a prospective, controlled, randomized study. Eleven patients (AA group) received infusion of mixed amino acids (11.4 gm), 11 patients (AA + GIK group) received infusion of mixed amino acids (11.4 gm) and insulin solution (225 IU insulin, glucose with glucose clamp technique, and potassium), and 11 patients served as control subjects.

Results: Amino acid infusion alone had no effect on systemic vascular resistance or cardiac index but increased renal blood flow 51% ± 11% (from 114 ± 13 to 172 ± 24 ml · min^–1 · m^–2 in one kidney, p < 0.05 vs the control group). Insulin solution in addition to amino acid infusion reduced systemic vascular resistance 24% ± 3% (from 1280 ± 85 to 960 ± 57 dyn · sec · cm^–5, p < 0.05 vs the control and AA groups) and increased cardiac index 13% ± 3% (from 2.3 ± 0.2 to 2.6 ± 0.2 L · min^–1 · m^–2, p < 0.05 vs the control and AA groups). Insulin had no significant additive effect on renal blood flow.

Conclusions: Our data imply that (1) infusion of mixed amino acids enhances renal blood flow after cardiac operations but has no effect on systemic perfusion and (2) the addition of insulin solution improves systemic perfusion. The combined treatment may potentially reduce the risk of renal hypoperfusion injury in the postoperative period after coronary artery bypass grafting.

This article has been cited by other articles:

				D. W. Quinn, D. Pagano, R. S. Bonser, S. J. Rooney, T. R. Graham, I. C. Wilson, B. E. Keogh, J. N. Townend, M. E. Lewis, P. Nightingale, et al. Improved myocardial protection during coronary artery surgery with glucose-insulin-potassium: A randomized controlled trial J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 34 - 42. [Abstract] [Full Text] [PDF]

				L. Lindholm, V. Hansdottir, M. Lundqvist, and A. Jeppsson The relationship between mixed venous and regional venous oxygen saturation during cardiopulmonary bypass Perfusion, March 1, 2002; 17(2): 133 - 139. [Abstract] [PDF]

				A. Jeppsson, R. Ekroth, P. Friberg, K. Kirno, I. Milocco, F. N. Nilsson, S. Svensson, and J. Wernerman Renal Effects of {alpha}-Ketoglutarate Early After Coronary Operations Ann. Thorac. Surg., March 1, 1998; 65(3): 684 - 690. [Abstract] [Full Text]