ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Myocardial protection: standard versus insulin cardioplegia and glucose-insulin-potassium solutions
Müzeyyen İyigün Kurt1, Nurgül Yurtseven1, Abdullah Kemal Tuygun2, Dilek Savaşkan1, Sevim Canik1
1Department of Anesthesiology and Reanimation, Siyami Ersek Cardiovascular Surgery Center, İstanbul
2Department of Cardiovascular Surgery, Siyami Ersek Cardiovascular Surgery Center, İstanbul
Background: This study determined the hemodynamic and metabolic effects of insulin cardioplegia, glucose-insulin-potassium (GIK) solution combined with insulin cardioplegia, and bloodonly cardioplegia on postoperative recovery in coronary artery bypass grafting (CABG).

Methods: One-hundred and twenty patients with normal ventricle function and no history of diabetes mellitus (DM) were randomly divided into three groups. During the operation, 10 IU/L of crystalized insulin-added blood cardioplegia was administered to the patients in group 1 (n=40) and group 2 (n=40), and standard blood cardioplegia was used in group-3 (n=40). In addition, GIK solution was started before the removal of cross-clamp (CC) period in group 2. The blood samples from arterial and coronary sinus were collected before CC application (T0), before CC removal (T1) and 0, 5th, 10th, and 15th minutes (T2-T3-T4-T5) after CC removal. Hemodynamic parameters were measured at the 30th minute after anesthesia induction and 1st and 24th hours following surgery. During the peri- and postoperative course, the need for defibrillation, inotropic and intraaortic balloon pump support, the incidence of postoperative arrythmias, duration of intubation, intensive care unit stay and hospitalization were recorded.

Results: The levels of arterial and coronary sinus lactate were significantly lower in group 2 compared to group 3 in the 5th, 10th, and 15th minutes. The blood glucose levels of arterial and coronary sinus were significantly higher in group 3. In group 2, the incidence of postoperative arrythmias and requirement for inotropic support was less than that of group 1 and group 3 (p<0.05).

Conclusion: After CABG, in the reperfusion period, persistant release of lactate or higher lactate levels demonstarate that myocardial protection was unsatisfactory and the recovery of aerobic metabolism was diminished perioperatively. Glucose-insulinpotassium solution combined with insulin cardioplegia decreases the myocardial lactate level, incidence of arrythmias, and requirement for inotropic support and leads to better myocardial protection.

Keywords : Coronary artery bypass surgery; glucose; insulin; intraaortic balloon pumping; metabolism; myocardium; neurosecretory system; potassium
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