High thoracic epidural analgesia decreases stress hyperglycemia and insulin need in cardiac surgery patients
Acta Anaesthesiologica Scandinavica, 07/05/2012
Greisen J et al. – High thoracic epidural analgesia (HTEA) preserves glucose metabolism better and leads to a lesser degree of ‘stress hyperglycaemia’ in cardiac surgery patients.Methods
- Forty–two low–risk patients age 65–79years scheduled for elective coronary artery bypass grafting with or without aortic valve replacement were randomised to receive HTEA as supplement for general anaesthesia.
- BG and lactate were measured before and after cardiopulmonary bypass and postoperatively at least every 3h together with administration of insulin.
- Postoperative pain was evaluated 30min, 2, 4 and 6h after extubation, and before discharge from the intensive care unit.
- Overall BG levels showed great variation over time (P<0.001).
- No statistically significant difference was found in perioperative BG, but postoperative lower BG levels were found in HTEA patients (P=0.042).
- The number of patients not receiving insulin in postoperative period was significantly higher in HTEA group (9 vs. 2, P=0.032).
- No differences were seen in lactate levels. Patients in the HTEA group had significant lower pain scores (P<0.001).