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Published on: March 27, 2018
Glycemic Control in Coronary Artery Bypass Graft Surgery: A Different Perspective
Vali Imantalab1, Abbas Sedighinejad1, Ali Mohammadzadeh Jouryabi1
1Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Insights
High blood glucose during coronary artery bypass graft surgery (CABG) is linked to adverse outcomes. This study found coronary sinus glucose levels higher than peripheral levels in CABG patients, indicating potential management improvements.
Area of Science:
- Cardiology
- Anesthesiology
- Metabolic Medicine
Background:
- Hyperglycemia during coronary artery bypass graft surgery (CABG) is a significant predictor of adverse intra- and post-operative outcomes.
- Effective glycemic management is crucial for improving patient safety and surgical results.
Purpose of the Study:
- To assess the quality of glycemic control during CABG surgery.
- To compare peripheral blood glucose (BG) levels with coronary sinus BG levels in CABG patients.
Main Methods:
- A prospective descriptive study involving 55 patients undergoing on-pump CABG.
- Peripheral BG was measured at five time points (T0-T4).
- Coronary sinus BG samples were collected during surgery.
Main Results:
- Statistically significant BG variations were observed throughout the surgery (P < 0.0001).
- Higher Body Mass Index (BMI) and American Society of Anesthesiologists (ASA) class III were associated with elevated BG levels.
- Coronary sinus BG averaged 222.18 ± 75.74 mg/dL, significantly higher than peripheral levels.
Conclusions:
- Current glycemic management protocols for CABG patients were deemed acceptable.
- Coronary sinus BG levels were consistently higher than peripheral BG levels, suggesting a need for further investigation and potential protocol refinement.
Background:
Hyperglycemia during coronary artery bypass graft surgery (CABG) strongly predicts intra- and post-operative adverse consequences.
Objectives:
This study aimed to evaluate the quality of glycemic management during CABG in an academic center regarding peripheral blood and coronary sinus values.
Methods:
This prospective descriptive study encompassed 55 eligible patients undergoing on-pump CABG surgery in 2020. Peripheral blood glucose (BG) was measured four times, before anesthesia induction (T0), before cardiopulmonary bypass pump (CPB) (T1), during CPB (T2), at the end of CPB (T3), and at the end of surgery (T4). The surgeon also took a sample of the coronary sinus BG.
Results:
The BG variations from T0 to T4 were statistically significant (P < 0.0001). The higher values detected in the ASA class III compared to ASA classes II were statistically significant at T1 (P = 0.01) and T2 (P = 0.025): patients with the higher BMI showed the higher levels of BG. In this regard, the differences were significant at T0 (P = 0.0001), T2 (P = 0.004), and T3 (P = 0.015). Regarding coronary sinus, the mean BG was 222.18 ± 75.74 mg/dL. It was also observed that the ASA class III (P = 0.001), longer duration of CPB (P = 0.021), higher IV fluid volume administrated during surgery (P = 0.023), higher BMI (P = 0.0001), and less urine volume at the end of surgery (P = 0.049) were significantly associated with the higher BG of the coronary sinus.
Conclusions:
The existing glycemic management protocols on the CABG patients were acceptable in our hospital. However, the BG level of the coronary sinus was higher than the peripheral one.
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