Article

OP-131 Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence after Coronary Artery Bypass Operations in Diabetic Patients?

Department of Anesthesiology, University of Suleyman Demirel, Isparta, Turkey.
Journal of cardiothoracic and vascular anesthesia (Impact Factor: 1.48). 06/2008; 22(3):383-7. DOI: 10.1053/j.jvca.2007.09.015
Source: PubMed

ABSTRACT To compare continuous insulin infusion (CII) and intermittent subcutaneous insulin therapy for preventing supraventricular tachycardia. The authors propose that continuous insulin therapy is more effective to reduce supraventricular tachycardias.
A prospective randomized study.
This study was performed in 2 different centers between April 2005 and February 2007: Gülhane Military Medical Academy and University of Süleyman Demirel.
Two hundred diabetic patients were included in this prospective randomized study. Patients were divided into 2 groups according to their insulin therapy in 2 different centers.
Group 1 included 100 diabetes mellitus (DM) patients, and CIIs were administrated. These patients received a CII infusion titrated per protocol in the perioperative period (Portland protocol). Group 2 also included 100 DM patients, and subcutaneous insulin was injected every 4 hours in a directed attempt to maintain blood glucose levels below 200 mg/dL. Sliding scale dosage of insulin was titrated to each patient's glycemic response during the prior 4 hours.
There were 5 hospital mortalities in the intermittent insulin group. The causes of death were pump failure in 3 patients and ventricular fibrillation in 2 patients. There were 2 hospital mortalities in the CII group (p = 0.044). Thirty-six patients in the intermittent insulin group and 21 patients in the CII group required positive inotropic drugs after cardiopulmonary bypass (p = 0.028). Low cardiac output developed in 28 and 16 patients in the intermittent and CII groups, respectively (p = 0.045). Univariate analysis identified positive inotropic drug requirement (p = 0.011, odds ratio [OR] = 3.41), ejection fraction (EF) (p = 0.001, OR = 0.92), cross-clamp time (p = 0.046, OR = 0.97), left internal mammary artery (p = 0.023, OR = 0.49), chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second <75% of predicted value (p = 0.009, OR = 2.02), intra-aortic balloon pump (p = 0.045, OR = 1.23), body mass index (p = 0.035 OR = 5.60), and CII (p < 0.001, OR = 0.36) as predictors of SVT. Stepwise multivariate analysis confirmed the significance of some of the previously mentioned variables as predictors of SVT. The value of -2 log likelihood of multivariate analyses was 421.504. These were EF (p < 0.001, OR = 0.91), positive inotropic drug requirement (p < 0.001, OR = 3.94), COPD (p = 0.036, OR = 2.11), and CII (p < 0.001, OR = 0.19).
Continuous insulin therapy in the perioperative period reduces infectious complications, such as sternal wound infection and mediastinitis, cardiac mortality caused by pump failure, and the risk of development of supraventricular tachycardias.

0 Followers
 · 
77 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background This study aimed to determine the safety and efficacy of intraoperative intensive glycaemic treatment with modified glucose-insulin-potassium solution by hyperinsulinemic normoglycaemic clamp in cardiopulmonary bypass surgery patients. We hypothesised that the treatment would reduce infection rates in this group of patients.MethodsA prospective, randomised, double-blind trial was conducted in cardiopulmonary bypass surgery patients. A total of 199 adult patients (out of a planned 400) were randomly allocated to intensive or conventional treatment with target glucose levels of 4.4–8.3 mmol/l and < 13.8 mmol/l, respectively. The primary outcomes were clinical infection and cytokine levels, including interleukin (IL)-6 and IL-10. The secondary outcomes were morbidity and mortality.ResultsThe study was terminated early because of safety concerns (hypoglycaemia). The clinical post-operative infection rate was 17% in the intensive group and 13% in the conventional group (P = 0.53). The proportion of patients with hypoglycaemia was significantly higher in the intensive group (23%) compared with the conventional group (3%) (P < 0.001). Morbidity and mortality rates were similar for both groups. Anaesthetic duration > 2 h (vs. ≤ 2 h), pre-operative IL-6 level > 15 pg/ml (vs. ≤ 15 pg/ml) and post-operative IL-6 level 56–110 pg/ml (vs. ≤ 55 pg/ml) were independent predictors for post-operative infection.Conclusions Intraoperative intensive glycaemic treatment significantly increased the risk of hypoglycaemia, but its effect on post-operative infection by clinical assessment could not be determined. Anaesthetic duration, pre-operative and post-operative IL-6 levels can independently predict post-operative infection.
    Acta Anaesthesiologica Scandinavica 04/2014; DOI:10.1111/aas.12305 · 2.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper reviews a learning process for the development of a model of a specific physiological control system. It provides an example of a nonlinear system structure, and elucidates processes of aggregating biological variables and of decomposing a system model at different time scales. A quasilinear approximate analysis of the model suggests an adaptive control mechanism which is yet to be explored.
    Decision and Control including the 13th Symposium on Adaptive Processes, 1974 IEEE Conference on; 01/1974
  • [Show abstract] [Hide abstract]
    ABSTRACT: To begin, we must agree on what we mean by a learning system and a learning control system. A system is called learning if the information pertaining to the unknown features of a process or its environment is acquired by the system, and the obtained experience is used for future estimation, recognition, classification, decision or control such that the performance of the system will be improved. A learning system is called a learning control system if the acquired information is used to control a process with unknown features (these standardized definitions are taken from Reference 1). The attribute of "learning" that is associated with learning systems, derives from psychological learning theories, especially reinforcement learning theories.
    Decision and Control including the 13th Symposium on Adaptive Processes, 1974 IEEE Conference on; 01/1974