Abstract
Background & Objective:Recent meta-analysis reports have called for more randomized trials to evaluate the effectiveness of GIK solution in patients of cardiac surgery. So this study was conducted to evaluate the effectiveness of Glucose-insulin-potassium (GIK) solutions in non-diabetic patients undergoing coronary artery bypass grafting.Methods:A total number of one hundred and sixty (160) patients were randomized into two equal groups; GIK Group and non-GIK group. In GIK group, 5% dextrose containing 70 IU/L regular insulin and 70 meq/L of potassium was administered. The infusion was started at a rate of 30 ml/hour after induction of anesthesia and before the start of cardiopulmonary bypass. The infusion was started again after removal of aortic cross clamp and was continued for six hours after the operation.Results:In early post-operative period, peak CKMB levels were high in non-GIK group 48.50±19.79 IU/L versus 33.40±14.69 IU/L in GIK group (p-value <0.001). There was no statistically significant difference in requirements of inotropic support between the groups. The mean duration of inotropic support in GIK group was only 5.50±6.88 hours in GIK group and 8.64±7.74 hours in non-GIK group (p-value 0.008). Mean ventilation time in GIK group was 5.06±2.39 hours versus 6.55±3.58 hours in non-GIK group (p-value 0.002). Similarly, ICU stay period was also shorter in GIK group (p-value 0.01). We did not found any detrimental effect of GIK infusion on non-cardiac complications e.g. renal, pulmonary and neurologic complications.Conclusion:Glucose-insulin-potassium (GIK) infusion has a beneficial role in myocardial protection and is associated with better post-operative outcomes without increasing the risk of non-cardiac complications.
Highlights
Use of glucose insulin and potassium (GIK) solution for myocardial protection was 1st time introduced by Sodi-Pollares and colleagues
During coronary artery bypass grafting (CABG), the myocardium is subjected to endure the periods of ischemia and reperfusion which may result in post-ischemia contractile dysfunction
Most of these studies were conducted in diabetic patients and few studies have been conducted in nondiabetic patients regarding effectiveness of GIK solution in cardiac surgery patients
Summary
Use of glucose insulin and potassium (GIK) solution for myocardial protection was 1st time introduced by Sodi-Pollares and colleagues. That is a major contributor of early and late morbidity and mortality and increased requirement of pharmacologic and mechanical circulatory support.[11,12] Meta-analysis by Bothe et al involving 11 randomized trials concluded that GIK administration associated with improved postoperative contractile function and reduced risk of atrial arrhythmias after cardiac surgery.[13] Most of these studies were conducted in diabetic patients and few studies have been conducted in nondiabetic patients regarding effectiveness of GIK solution in cardiac surgery patients In this clinical trial we evaluated the effectiveness of GIK solutions regarding myocardial protection and early postoperative surgery outcomes in non-diabetic patients undergoing coronary artery bypass grafting. Conclusion: Glucose-insulin-potassium (GIK) infusion has a beneficial role in myocardial protection and is associated with better post-operative outcomes without increasing the risk of non-cardiac complications
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