Perioperative glycemic control in diabetic patients undergoing coronary artery bypass graft surgery

Abstract

BackgroundThe concept of perioperative glycemic control in cardiac surgery patients was conducted in many studies, however, it remains unclear how tight the glycemic control should be. Our aim is to study the effect of perioperative tight glycemic control versus moderate glycemic control on the outcome of diabetic patients undergoing coronary artery bypass graft (CABG) surgery. MethodsThis study is a randomized prospective study conducted on 135 diabetic patients planned for CABG surgery. Patients were divided into 2 groups: group A subjected to tight glycemic control during operation to maintain blood glucose level between 110 and 149 mg/dl and group B subjected to conventional moderate glycemic control to achieve blood glucose level between 150 and 180 mg/dl using continuous insulin infusion started before anesthesia induction and continued till the patient is extubated in ICU. Both groups were followed up till 1 month after operation regarding operative mortality and postoperative outcome. ResultsNo significant difference between both groups in mortality, however there was statistical significant relationship between tight glycemic control group and lowered incidence of postoperative atrial fibrillation, sternal wound infection, need for inotropic support and reduced time spent on mechanical ventilation. We noticed reduction in incidence of acute renal failure in tight glycemic control with no difference between both groups in neurological insults, renal dysfunction and perioperative myocardial infarction. ConclusionTight glycemic control improved perioperative outcome in diabetic CABG patients. Maintaining perioperative blood glucose level between 110 and 149 mg/dl is safe and should be recommended as a routine practice in diabetic patients undergoing CABG surgery.