Glycemic Control in Coronary Artery Bypass Graft Surgery: A Different Perspective

Vali Imantalab; Abbas Sedighinejad; Ali Mohammadzadeh Jouryabi; Gelareh Biazar; Gholamreza Kanani; Mohammad Haghighi; Haniyeh Sadat Fayazi; Golnoosh Ghasvareh

doi:10.5812/aapm.120073

Glycemic Control in Coronary Artery Bypass Graft Surgery: A Different Perspective

Anesth Pain Med. 2022 Jan 3;11(6):e120073. doi: 10.5812/aapm.120073. eCollection 2021 Dec.

Authors

Vali Imantalab¹, Abbas Sedighinejad¹, Ali Mohammadzadeh Jouryabi¹, Gelareh Biazar¹, Gholamreza Kanani², Mohammad Haghighi¹, Haniyeh Sadat Fayazi³, Golnoosh Ghasvareh⁴

Affiliations

¹ Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
² Department of Cardiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
³ Razi Clinical Reseach Development Unit, Guilan University of Medical Sciences, Rasht, Iran.
⁴ Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Abstract

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.

Keywords: Blood Glucose; Coronary Artery Bypass Surgery; Coronary Sinus.