Glycemic Control during Coronary Artery Bypass Graft Surgery

Abstract

Hyperglycemia, which occurs in the perioperative period during cardiac surgery, has been shown to be associated with increased morbidity and mortality. The management of perioperative hyperglycemia during coronary artery bypass graft surgery and all cardiac surgical procedures has been the focus of intensive study in recent years. This report will paper the pathophysiology responsible for the detrimental effects of perioperative hyperglycemia during cardiac surgery, show how continuous insulin infusions in the perioperative period have improved outcomes, and discuss the results of trials designed to determine what level of a glycemic control is necessary to achieve optimal clinical outcomes.

Perioperative catabolism

“…80 In contrast, more recent studies in cardiac patients failed to show any benefit but reported an increased incidence of hypoglycemia. [81][82][83][84] All these studies were small and some were retrospective.…”

Alcohol consumption improves insulin signaling in the myocardium

“…Insulin promotes glucose uptake and optimizes glucose metabolism by stimulating pyruvate dehydrogenase and aerobic metabolism. 16 Insulin also inhibits the release of free fatty acids, which prevents free fatty acid mediated depressed contractility, oxidative stress, endothelial dysfunction, and inhibition of insulin signaling. 16-18 Insulin also has anti-inflammatory properties by inhibiting pro-inflammatory transcription factor NFKB and decreasing inflammatory mediators including IL-6 and TNFα.…”

“…16 Insulin also inhibits the release of free fatty acids, which prevents free fatty acid mediated depressed contractility, oxidative stress, endothelial dysfunction, and inhibition of insulin signaling. 16-18 Insulin also has anti-inflammatory properties by inhibiting pro-inflammatory transcription factor NFKB and decreasing inflammatory mediators including IL-6 and TNFα. 19 Taken together, the beneficial effects of insulin in ischemic myocardium on the cellular level translate to improved outcomes in patients undergoing coronary artery bypass surgery supplemented with insulin.…”

Blood glucose management in the patient undergoing cardiac surgery: A review

“…Diabetics display a significant deregulation of the miRNAs involved in angiogenesis, vascular repair, and endothelial function [27] . Ultimately, increased oxidative vascular stress causes thrombosis, impaired platelet function, and plaque rupture-all of which will result in reduced patency of grafts, reduced ischemic events, and a greater incidence of repeat revascularization in both coronary artery disease and diabetes [28] . Hyperglycemia is associated with worse outcomes after acute coronary syndrome, acute myocardial infarction, or coronary artery surgery.…”