scholarly journals Hyperinsulinemic-normoglycemic clamp administered together with amino acids induces anabolism after cardiac surgery

2016 ◽  
Vol 311 (6) ◽  
pp. R1085-R1092 ◽  
Author(s):  
Takumi Codère-Maruyama ◽  
Thomas Schricker ◽  
Dominique Shum-Tim ◽  
Linda Wykes ◽  
Evan Nitschmann ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Glucose Production ◽  
Endogenous Glucose Production ◽  
Whole Body ◽  
High Dose ◽  
Protein Balance ◽  
Body Protein

Cardiac surgery triggers an inflammatory stress response, leading to protein catabolism, a process that even high-dose insulin therapy alone cannot reverse. To determine whether hyperinsulinemic-normoglycemic clamp and perioperative amino acid (AA) supplementation improves whole body protein balance, 20 patients scheduled for elective coronary artery bypass grafting surgery were randomly assigned to have intra- and postoperative hyperinsulinemic-normoglycemic clamp, with or without intravenous AA supplementation. Primed continuous infusions of [6,6-2H2]glucose and l-[1-13C]leucine were used to quantify whole body protein and glucose metabolism before and after surgery. Adipose tissue and serum cytokines were also analyzed to measure their responsiveness to the anabolic effect of AA administration. During hyperinsulinemic-normoglycemic clamp, AA supplementation successfully stimulated whole body protein synthesis, resulting in a positive whole body protein balance after surgery (insulin: −13.6 ± 4.5 vs. insulin + AA: 2.1 ± 5.4 μmol·kg−1·h−1, P < 0.001). Endogenous glucose production was equally suppressed in both groups (insulin: 0.0 ± 3.8 vs. insulin + AA 1.6 ± 1.6 μmol·kg−1·min−1, P = 0.230). AA supplementation led to significant changes in serum and tissue IL-6 (insulin: 246.6 ± 111.2 vs. insulin + AA: 124.5 ± 79.3 pg/ml, P = 0.011). In conclusion, hyperinsulinemic-normoglycemic clamp technique, together with AA supplementation, can induce an anabolic state after open-heart surgery, as quantified by a positive whole body protein balance.

Postoperative Infusion of Amino Acids Induces a Positive Protein Balance Independently of the Type of Analgesia Used

2006 ◽  
Vol 105 (2) ◽  
pp. 253-259 ◽  
Author(s):  
Francesco Donatelli ◽  
Thomas Schricker ◽  
Giovanni Mistraletti ◽  
Francisco Asenjo ◽  
Piervirgilio Parrella ◽  
...  
Keyword(s):  
Amino Acids ◽  
Protein Synthesis ◽  
Epidural Analgesia ◽  
Glucose Production ◽  
Endogenous Glucose Production ◽  
Whole Body ◽  
Protein Balance ◽  
Body Protein ◽  
Leucine Oxidation ◽  
Endogenous Glucose

Background Net loss of body protein is a prominent feature of the catabolic response to surgical tissue trauma. Epidural analgesia with hypocaloric dextrose has been demonstrated to attenuate leucine oxidation but was unable to make protein balance positive. The current study was set to determine whether an infusion of amino acids on the second day after colon surgery would revert the catabolic state and promote protein synthesis while maintaining glucose homeostasis in patients receiving epidural analgesia as compared with patient-controlled analgesia with morphine (PCA). Methods Sixteen patients undergoing colorectal surgery were randomly assigned to receive epidural blockade or PCA as analgesic techniques and underwent a 6-h stable isotope infusion study (3 h fasted, 3 h fed) on the second postoperative day. Whole body glucose kinetics and protein turnover were measured using [6,6-2H2]glucose and l-[1-13C]leucine as tracer. Results The infusion of amino acids caused a decrease in endogenous glucose rate of appearance in both groups (P &lt; 0.05), with greater changes in the PCA group (P &lt; 0.05). Administration of amino acids suppressed the appearance of leucine from protein breakdown in both groups (P &lt; 0.05), although the decrease was greater in the PCA group (P &lt; 0.05). Leucine oxidation increased in both groups (P &lt; 0.05), with greater change in the epidural group (P &lt; 0.05). Protein synthesis increased to the same extent in both groups (P &lt; 0.05). Protein balance became positive after the infusion of amino acids, and the effect was greater in the PCA group (P &lt; 0.05). Conclusions Infusion of amino acids decreased the endogenous glucose production and induced a positive protein balance independent of the type of anesthesia provided, although such effects were greater in the PCA group.

Abstract 266: Incidence, Predictors and Outcomes of Permanent Pacemaker Implantation Among Patients With Bradyarrhythmias Following Cardiac Surgery: Insights From the National Inpatient Sample Database

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Karol Quelal ◽  
Olakanmi Olagoke ◽  
Jose Baez
Keyword(s):  
Cardiac Surgery ◽  
Valve Replacement ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Hospital Death ◽  
National Inpatient Sample ◽  
Permanent Pacemaker Implantation

Introduction: Significant atrioventricular blocks and bradyarrhythmias are known complications of open-heart surgery. These are frequently transient, however, some patients go on to need a permanent pacemaker (PP). We sought to describe the incidence, predictors, and outcomes of PP implantation among patients admitted for cardiac surgery who develop bradyarrhythmias. Methods: We queried the National Inpatient Sample (NIS) database from 2010 to 2014 for adults admitted for surgical valve replacement, valvuloplasty or coronary artery bypass grafting (CABG) who had bradyarrhythmias during the admission using the appropriate ICD codes. We identified patients who had permanent pacemaker implantation documented during the admission. Categorical and continuous variables were compared using the chi-square and student's t-test. Predictors of PP implantation and in-hospital mortality were evaluated by logistic regression. Results: Of the 1402930 patients who underwent cardiac surgery, 94748 patients had bradyarrhythmias defined as sinoatrial node dysfunction (SND) and/or atrioventricular block (AVB) during hospitalization. The primary procedure was identified as valve replacement in 50.3% (47615 of 94748), CABG in 29.9% (27622 of 94748) and valvuloplasty in 8.7% (8248 of 94748). SND was found in 29.9% (28372 of 94748) and AVB in 76% (72017 of 94748). Permanent pacemaker implantation was done in 39.3% (37246 of 94748). Valve replacement was the most common surgery associated with PP implantation [58% (21682 of 37246) compared to 21.5% in CABG (8007 of 37246) and 7.7% in valvuloplasty (2882 of 37246), p < 0.001). Female sex aOR 1.36 (95% CI 1.31 - 1.40), young age 18 - 44 years aOR 1.36 (95% CI 1.24 - 1.49), Asiatic and Hispanic origin aOR 1.36 (95% CI 1.23 - 1.51), aOR 1.25 (95% CI 1.17 - 1.34) respectively, diabetes mellitus with chronic complications aOR 1.16 (95% CI 1.09 - 1.24), drug abuse aOR 1.38 (95% CI 1.21 - 1.55) were associated with higher odds of pacemaker implantation. African American origin aOR 0.79 (95CI 0.74 - 0.85), AIDS aOR 0.33 (95% CI 0.17 - 0.67), south hospital region aOR 0.89 (95% CI 0.85 - 0.93), no-charge admissions aOR 0.66 (95% CI 0.49 - 0.89) were associated with a lower odds of PPM implantation. Death during hospitalization was found in 3% of the patients. After multivariable regression, PP implantation was associated with a lower likelihood of in-hospital death aOR 0.45 (95% CI 0.41 - 0.50). Conclusion: Approximately one-third of the patients hospitalized for cardiac surgery related to AVB and/or SND were implanted a permanent pacemaker. Factors like age, sex, race and comorbidities determine the likelihood of this procedure that has a significant impact on mortality. Having a better insight into these predictors would allow a better triage of patients who would benefit from its implantation.

Glucose and insulin administration while maintaining normoglycemia inhibits whole body protein breakdown and synthesis after cardiac surgery

2014 ◽  
Vol 117 (11) ◽  
pp. 1380-1387 ◽  
Author(s):  
Roupen Hatzakorzian ◽  
Dominique Shum-Tim ◽  
Linda Wykes ◽  
Ansgar Hülshoff ◽  
Helen Bui ◽  
...  
Keyword(s):  
Amino Acids ◽  
Glucose Production ◽  
Endogenous Glucose Production ◽  
Whole Body ◽  
Control Group ◽  
Protein Breakdown ◽  
Body Protein ◽  
Cabg Surgery ◽  
Insulin Group ◽  
Endogenous Glucose

We investigated the effect of insulin administered as part of a hyperinsulinemic-normoglycemic clamp on protein metabolism after coronary artery bypass grafting (CABG) surgery. Eighteen patients were studied, with nine patients in the control group receiving standard metabolic care and nine patients receiving insulin (5 mU·kg−1·min−1). Whole body glucose production, protein breakdown, synthesis, and oxidation were determined using stable isotope tracer kinetics (l-[1-13C]leucine, [6,6-2H2]glucose) before and 6 h after the procedure. Plasma amino acids, cortisol, and lactate were also measured. Endogenous glucose production (preoperatively 10.0 ± 1.6, postoperatively 3.7 ± 2.5 μmol·kg−1·min−1; P = 0.0001), protein breakdown (preoperatively 105.3 ± 9.8, postoperatively 85.2 ± 9.2 mmol·kg−1·h−1; P = 0.0005) and synthesis (preoperatively 88.7 ± 8.7, postoperatively 72.4 ± 8.4 mmol·kg−1·h−1; P = 0.0005) decreased in the presence of hyperinsulinemia, whereas both parameters remained unchanged in the control group. A positive correlation between endogenous glucose production and protein breakdown was observed in the insulin group ( r2 = 0.385). Whole body protein oxidation and balance decreased after surgery in patients receiving insulin without reaching statistical significance. In the insulin group the plasma concentrations of 13 of 20 essential and nonessential amino acids decreased to a significantly greater extent than in the control group. In summary, supraphysiological hyperinsulinemia, while maintaining normoglycemia, decreased whole body protein breakdown and synthesis in patients undergoing CABG surgery. However, net protein balance remained negative.

Effects of growth hormone and IGF-I on glucocorticoid-induced protein catabolism in humans

1996 ◽  
Vol 270 (4) ◽  
pp. E552-E558 ◽  
Author(s):  
M. Oehri ◽  
R. Ninnis ◽  
J. Girard ◽  
F. J. Frey ◽  
U. Keller
Keyword(s):  
Growth Hormone ◽  
Plasma Concentrations ◽  
Glucose Production ◽  
Endogenous Glucose Production ◽  
Whole Body ◽  
Protein Catabolism ◽  
Body Protein ◽  
Glucose Clearance ◽  
Igf I ◽  
Endogenous Glucose

The effects of similar increases in total insulin-like growth factor I (IGF-I) plasma concentrations achieved by either recombinant human (rh) growth hormone (GH) or rhIGF-I administration on whole body protein and glucose kinetics were assessed. Twenty-six healthy subjects received methylprednisolone (0.5 mg.kg-1.day-1 orally) during 6 days in combination with either placebo (saline sc), GH (0.3 mg.kg-1.day-1 sc), or IGF-I (80 micrograms.kg-1.day-1 sc) in a double-blind randomized fashion. Glucocorticoid administration resulted in protein catabolism as indicated by an increase in leucine flux and a 62 +/- 13% increase in leucine oxidation ([1-13C]leucine infusion technique); this increase was abolished by GH (-1 +/- 18%) as was statistically insignificant during IGF-I treatment (+53 +/- 25%). GH increased endogenous glucose production by 28 +/- 8%, augmented glucocorticoid-induced insulin resistance of peripheral glucose clearance (euglycemic clamp), and increased circulating lipids. IGF-I administration resulted in both increased endogenous glucose production and increased peripheral glucose clearance such that plasma glucose concentrations remained unchanged by IGF-I. IGF-I lowered circulating GH and insulin and altered IGF binding proteins, which all may have reduced bioactivity of IGF-I. The data demonstrate that, in spite of similar total IGF-I plasma concentrations during treatment, GH and IGF-I exert markedly different effects on whole body leucine, glucose, and lipid metabolism.

TNF directly stimulates glucose uptake and leucine oxidation and inhibits FFA flux in conscious dogs

1996 ◽  
Vol 270 (5) ◽  
pp. E864-E872 ◽  
Author(s):  
Y. Sakurai ◽  
X. J. Zhang ◽  
R. R. Wolfe
Keyword(s):  
Glucose Production ◽  
Baseline Period ◽  
Endogenous Glucose Production ◽  
Whole Body ◽  
Constant Infusion ◽  
Direct Effects ◽  
Body Protein ◽  
Leucine Oxidation ◽  
Period 2 ◽  
Plasma Ffa

We tested the hypothesis that the metabolic changes in glucose, lipid, and protein metabolism seen during tumor necrosis factor (TNF) infusion were due to the increase in plasma glucagon concentration rather than to the direct effects of TNF. We employed a pancreatic clamp technique to keep plasma insulin and glucagon concentrations constant throughout a 4-h isotope infusion. Glucose, lipid, and protein kinetics were measured by means of the primed, constant infusion of [6,6-2H]glucose, [2H5]glycerol, [2H2]palmitic acid, and [1-13C]leucine. After a 2-h baseline period (period 1), TNF was infused as a primed, constant infusion (prime, 2.5 micrograms/kg; constant infusion, 62.5 ng.kg-1.min-1) for 2 h (period 2). Whereas plasma glucose concentration dropped significantly during TNF infusion, endogenous glucose production did not change. The decrease in glucose concentrations was due to a stimulation of glucose clearance (P < 0.05). The rate of lipolysis did not decrease significantly, but free fatty acid (FFA) flux and plasma FFA concentration significantly decreased during TNF infusion (P < 0.05). The rate of appearance of leucine was not affected by TNF infusion, but TNF caused a significant increase in 13CO2 excretion (P < 0.05) and leucine oxidation (P < 0.05). The calculated rates of whole body protein synthesis decreased. We concluded that TNF did not directly affect glucose production. Furthermore, changes in protein and lipid kinetics during TNF infusion were not mediated by changes in insulin or glucagon and may have reflected direct effects of TNF.

scholarly journals Effect of Alpha-Lipoic Acid on Atrial Fibrillation after Open Heart Surgery

2020 ◽  
Author(s):  
Wael Elfeky ◽  
Dalia R El-Afify
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Lipoic Acid ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Group Versus ◽  
Control Group ◽  
Alpha Lipoic Acid ◽  
Reactive Protein

Background: Postoperative atrial fibrillation (POAF) is associated with increased morbidity and mortality, and an inflammatory process is involved in its pathogenesis. We aimed to study the possible effect of alpha-lipoic acid (ALA) as an antioxidant on atrial fibrillation after cardiac surgery. Methods: The study included ninety patients who underwent cardiac surgery, either valvular or coronary artery bypass grafting using cardiopulmonary bypass, and were randomized into two groups: Control and ALA groups. Blood samples were obtained to measure preoperative and postoperative levels of malondialdehyde (MDA), glutathione, C-reactive protein (CRP) and interleukin-6 (IL-6). The patients were monitored for the occurrence of atrial fibrillation until the day of discharge. Results: POAF occurred in 33% in the control group versus 11% in the ALA group (p=0.011).  When compared to the control group, ALA significantly decreased the postoperative levels of MDA (4.78±0.91 vs. 5.36±1.03 nmol/ml; p= 0.006) CRP (19.44±3.14 vs. 26.56±6.29 mg/dl; p <0.001) and IL-6 (22.25±2.2 vs. 25.37±2.5 pg/ml; p< 0.001) while glutathione level increased significantly in patients who received ALA (26.4±4.59 vs. 23.44±5.11 mg/l; p= 0.005). Conclusion: ALA may help in the prevention of atrial fibrillation following cardiac surgery through exerting antioxidant and anti-inflammatory effects.

scholarly journals Effect of Cardiopulmonary Bypass on Postoperative Nutrition of Cardiac Surgery Patients

1970 ◽  
Vol 38 (2) ◽  
pp. 53-55
Author(s):  
Suman Nazmul Hosain ◽  
Sayeda Jarina Akter ◽  
Haroon Rasheed ◽  
Fazle Maruf ◽  
Nasiruddin Ahmed
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Critical Role ◽  
Open Heart Surgery ◽  
Whole Body ◽  
Calorie Intake ◽  
Open Heart ◽  
Postoperative Nutrition ◽  
Daily Food

Introduction: Nutrition is an important factor for recovery following cardiac surgery. Most patients loose appetite and have reduced nutrition following cardiac surgery. Several factors including pain, anxiety, medications, whole body inflammatory response, Cardiopulmonary bypass (CPB) have role in postoperative anorexia and reduced nutrition. Objective: Objective of this study is to find out the role of CPB in postoperative anorexia and nutrition. Methodology: This prospective study was conducted at NICVD. 30 randomly selected adult patients who had undergone open heart surgical procedures were compared to same number of closed heart surgery patients. The daily food intake was calculated from the ICU data-sheets and calorie value obtained. The values were compared between the open and closed heart surgery patients. Results: It was noted that the open heart surgery patients took significantly less amount of food and calorie compared to the closed heart surgery patients. Conclusion: Open heart surgery is a situation where post operative nutrition plays a very significant role in patient's recovery. But unfortunately there is a tendency of the patient's taking low calorie intake for various reasons. This may have a critical role postoperatively. So adequate measures should be adopted to ensure proper postoperative nutrition following open heart surgery.   DOI: 10.3329/bmj.v38i2.3574 Bangladesh Medical Journal 38(2) 2009 53-55

P4385Diaphragm dysfunction following cardiac surgery: role of ultrasound imaging for initial and follow-up assessment during cardiac rehabilitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Maranta ◽  
I Cartella ◽  
A Pistoni ◽  
L Cianfanelli ◽  
P Cerea ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Respiratory Cycle ◽  
Diaphragm Dysfunction ◽  
Surgical Interventions ◽  
Diaphragm Function ◽  
The Impact

Abstract Background Diaphragm dysfunction is a common complication of cardiac surgery, often underdiagnosed. Ultrasonography (US) is a promising technique for diaphragmatic assessment. Few trials have been conducted using US after heart surgery and no clear data exist on the recovery of diaphragm function after cardiovascular rehabilitation (CR). Purpose The aim of this study is to evaluate post-cardiac surgery diaphragm dysfunction using US and to assess the impact of an inpatient CR programme on its functional recovery. Methods In a single-centre prospective cohort study 97 consecutive patients hospitalised in our CR Unit were enrolled. 14 patients underwent aortic valve replacement, 38 mitral valve repair or replacement, 14 coronary artery bypass grafting (CABG), 22 combined surgery, and 9 other surgical interventions. We performed diaphragm US at admission and after 10 rehabilitative sessions. The following parameters were assessed: thickening fraction (TF) in B-mode on the right intercostal projections, and excursion, time of inspiration, time of a respiratory cycle and contraction velocity in M-mode on right anterior subcostal projections. Results After cardiac surgery, the incidence of diaphragm dysfunction and paralysis were 60% and 1%, respectively. Patients with TF <20% at admission showed a significant improvement in TF (13.30%, IQR 8.69–17.39 vs 27.27%, IQR 21.05–31.58; p<0.001), excursion (1.67cm, IQR 1.3–2.1 vs 2.23cm, IQR 1.9–2.7; p<0.001), time of inspiration (0.9s, IQR 0.9–1.07 vs 1.01s, IQR 0.87–1.13; p=0.005), time of a respiratory cycle (2.67s, IQR 2.38–3.05 vs 3.07s, IQR 2.68–3.35; p<0.001) and velocity (1.81cm/s, IQR 1.14–2.33 vs 2.24cm/s, IQR 1.92–2.76; p<0.001). On the contrary, in patients with a TF>20%, no additional improvement was observed. In both groups, there was a significant improvement in the parameters of physical performance. In particular, in the group with a TF<20%, the distance covered during the 6MWT (300m, IQR 205–370 vs 555m, IQR 450–612; p<0.001) and the energy cost of physical activity (2.60, IQR 2.13–2.92 vs 4.09, IQR 3.44–4.50; p<0.001) increased while the perception of exertion (Borg Scale 11, IQR 11–13 vs 13, IQR 12–13; p=0.011) was reduced. At the 10th day assessment, 51.5% of the total population had a recovery of diaphragm function, whilst 48.5% had a failure of recovery (TF relative change between admission and discharge <60%). The multivariate analysis identified CABG as an independent predictor of failure of diaphragm recovery (OR 5.44; CI 1.10–26.84, p=0.037). Conclusion US might be a valuable part of routine clinical practice for initial and follow-up assessment of patients after open-heart surgery. CR showed to be an effective strategy to improve diaphragm parameters in patients with post-surgical dysfunction. Progressive evaluation of diaphragm function may drive personalised rehabilitation programmes.

scholarly journals A study on correlation of coronary sinus lactate and troponin T levels with perioperative outcome in patients undergoing cardiac surgery on cardio pulmonary bypass

2021 ◽  
Author(s):  
Rupesh Kumar ◽  
Vidur Bansal ◽  
Subhendu Mahapatra ◽  
Gautam Sengupta
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Sinus ◽  
Heart Surgery ◽  
Troponin T ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Perioperative Outcomes ◽  
Aortic Cross Clamp ◽  
Pulmonary Bypass

Abstract Myocardial ischemia is a metabolic phenomenon that occurs in patients undergoing open heart surgery like coronary artery bypass grafting (CABG), valvular heart surgery, vascular surgeries etc., due to stress imposed during cardiopulmonary bypass (CPB), obligatory interruption of coronary blood flow during aortic cross clamp and reperfusion after aortic cross clamp release. The present study is designed to have a detailed study on estimation of coronary sinus lactate and troponin t levels in patients undergoing cardiac surgery with cardiopulmonary bypass and its correlation with various parameters related to the perioperative outcomes.

scholarly journals Factors for the development of atrial fibrillation after open heart surgery

2021 ◽  
Vol 10 (2) ◽  
pp. 40-44
Author(s):  
D. I. Lebedev ◽  
A. V. Evtushenko ◽  
A. A. Khorlampenko
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Left Atrium ◽  
Heart Valves ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Early Postoperative Period ◽  
C Reactive Protein ◽  
Reactive Protein

Aim. To identify the factors influencing the development of postoperative atrial fibrillation (POAF).Methods. The study included 100 patients with indications for cardiac surgery, aged 53 to 82 years (mean age 67.2±17 years). The group included patients who had no history of AF before surgery. Cardiac surgery in the group was presented in 63 patients by coronary artery bypass grafting, and in 37 – by intervention on the heart valves. All respondents were divided into 2 groups: the first included 39 people (39%) who had AF paroxysms lasting more than 30 seconds in the early postoperative period, with a peak at 1–2 days, in 13 (33.3%) cases of AF relapsed. The second group of patients was represented by 61 patients (61%) without cardiac arrhythmias after surgery.Results. The dependence of the development of POAF on age, the concentration of C-reactive protein in the peripheral blood taken on the day of cardiac surgery, the longitudinal size of the left atrium before surgery was revealed.Conclusion. It was found out that a number of factors such as age, preoperative left atrium size, C-reactive protein level in the first days after surgery suggest the development of POAF. The use of the predictors obtained can make it possible to develop an effective strategy for the prevention of POAF. 

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