>Archivos de Cardiología de México
>Year 2006, Issue S4
Rojas PEM, Luna OP, Serrano VX, Fernández RBJ, de Micheli A
Glucose-insulin-potassium (GIK) solution: Cardioprotective effects of insulin
Arch Cardiol Mex 2006; 76 (S4)
PDF: 104.15 Kb.
In the Anesthesiology Department of the Instituto Nacional de Cardiología The medical staff uses the glucose insulin potassium i.v. for myocardial protection. The energy is dereived from lipidic beta oxidation, glucose breakdown and amino acid catabolism in mitochondria. In myocardial ischemia, from de aortic cross clamping, the metabolic myocardial substrates diminished as well as the energy produced by adenosine (ATP). During myocardial ischemia, an increase in long chain lipids emhances mitochondrial permeability, promotes depletion of citochrome C and lost of the capability of transmembrane regulation. In the hipoperfused myocardium, by coronary vasoconstriction, short chain fatty acids oxidation predominates, if fatty metabolism during reperfusion is elevated. More of them will enter [ibm1] the Krebs cycle and, as a consequence, less energy will be produced. The glucose-insulin-potassium solution provides the glucose needed by the myocardium in reperfusion conditions and protects the cellular membrane’s integrity as well as pumps and ionic channels, it allows maintaining the action potential probably because ATP-depended channels block and prevent potassium loss, it reduces the cytosol calcium overload and prevent cardiac arrhythmias, preserves the sodium ATPasa pump avoiding the rise in cytosolic sodium; glucose prevents the production of free oxygen radicals. Fatty acids, during ischemia, are responsible for the metabolism and elevation of enzymes, such as acilcarnitine and acylcoenzime-A, which promote intracellular calcium overload and arrhythmias. The insulin has anti-inflammatory effects and anti-apoptoic effects. When blood glucose is controlled during the perioperative period the mortality is reduced
||Glucose-insulin-potassium solution, Myocardial protection, Effects of insulin.
Quattarra A, Lecomte P, Le Manach, Jacqueminet S, Platonov I, Poner N, et al: Poor intraoperative blood glucosa control is associated with a worsened hospital outcome alter cardiac surgery in diabetic patients. Anesthesiology 2005; 103: 687-94.
Gu W, Pagel PS, Waltier DC, Kersten JR: Modifying cardiovascular risk in diabetes mellitus. Anesthesiology 2003; 98: 774-9.
Kersten JR, Toller WG, Gross ER, Pagel PS, Waltier DC: Diabetes abolishes ischemic preaconditioning: Role of glucose, insulin, and osmolality. Am J Physiol Heart Circ Physiol 2000; 278: H1218-24.
Finney SJ, Zekveld C, Elia A, Evans TW: Glucose control and mortality in critically ill patients. JAMA 2003; 290: 2041-7.
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Shetz M: Intensive insulin therapy in the critically ill patients. N Engl J Med 2001; 345: 1359-67.
Krinsley JS: Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc 2003; 78: 1471-8.
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Shetz M, et al: Oucome benefit of intensive insulin therapy in the critically ill: Insuli does versus glycemic control. Crit Care Med 2003; 31: 359-66.
Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, et al: Continuos insulin infusion reduces mortality in patients whit diabetes undergoing coronary bypass cardiopulmonary grafting. J Thorac Cardiovasc Surg 2003; 125: 1007-21.
Lazar HI, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS: Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decresed recurrent ischemic events. Circulation 2004; 109: 1497-502.
Varvalho G, Moore A, Qizilbash B, Lapchapelle K, Schricker T: Maitenance of normoglycemia during cardiac surgery. Anesth Analg 2004; 99: 319-24.
Kersten JR, Pagel PS, Waltier D: Hyperglycemia: An independent predictor of cardiovascular risk. J Cardiothorac Vasc Anaesth 2001; 15: 404-6.
Ma H, Zhang HK, Yu L, Zhang QJ, Li J, Huo JH, et al: Vasculoprotective effect of insulin in the ischemic/reperfused canine heart: Role of Akt-stimulated NO production. Cardiovas Res 2006 69: 57-67.
Visser L, Zuurkier CJ, Hoek FJ, Opmeer BC, de Jonge E, de Mol BAJM, van Wezel HB: Glucose, insulin and potassium applied as perioperative hyperinsulinaemic normoglycaemic camp: effects on inflammatory response during coronary artery surgery. BJ of Anaesth. 2005: 95(4); 448-57.
Khaury W, Klausner JM, Ben-Abraham R, Szold O: Glucose control by insulin for critically III surgical patients. J Trauma 2004: 57; 1132-1134.
Laine H, Sundall J, Nuutila P, Raitakari OT, Luotolahti M, Elomao T, Knuuti J: Insulin induced increase in coronary flow reserve is abolished by dexamethasone in young men with uncomplicated type 1 diabetes. Heart 2004; 90: 270-276.
Bachwani AS, Kulkarni AR, Thakkar MG, Patel SJ: Role of insulin in the treatment of myocardial infarction. Chest 2004; 126: 825S.
Metha SR: Impact of glucose-insulin-potassium on mortality and morbidity in over 20,000 patients with acute myocardial infarction: The CREATE-ECLA international trial. Circulation 2005; 111: 1725-1726.
Mehta SR, Yusuf S, Diaz R, Zhu J, Pais P, Xavier D, et al: Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST segment elevation myocardial infarction. The CREATE-ECLA Randomized controlled trial. JAMA 2005; 293: 437-446.
Castro PF, Larrin G, Baeza R: Effects of glucose-insulin-potassium solution on myocardial salvage and left ventricular function after primary angioplasty. Crit Care Med 2003; 31: 2152-2155.
Wang P, Lloyd SG, Chattam JC: Impact of high glucose/high insulin and dichloroacetate treatment on carbohydrate oxidation and functional recovery after low-flow ischemia and reperfusion in the isolated perfused rat heart. Circulation 2005; 111: 2066-2072.
Yazici M, Demircan S, Durna K, Yasar E, Acar Z, Sahin M: Effect of glucose-insuline-potassium infusion on myocardial damage due to percutaneous coronary revascularization. Am J Cardiol 2005; 96: 1517-20.
Van der Horst IC, Ottervanger JP, van Thof AW, Rerffers S, Miedema K, Hoorntje JC, et al: The impact of glucose-insulin-potassium infusion in acute myocardial infartion on infart size and left ventricular ejection fraction. BMC Med 2005; 3: 9-15.
Lazar H: The insulin cardioplegia trial. J Thorac Cardiovasc Surg 2003; 5: 842-44.
Marfella R, Siniscalchi M, Esposito K: Effects of stress hyperglycemia on acute myocardial infarction: role of inflammatory immune process in functional cardiac outcome. Diabetes Care 2003; 26: 3129-35.
Vanhorebeek I, Langouche L, Van den Berghe G: Glycemic and nonglycemic effects of insulin: haow do they contribute to better aoutcome of critical illness? Curr O in Critical Care 2005, 11; 304-311.
Bergstra A, Svilaas T, van den Heuvel AF, van der Horst IC, Zijlstra F: Glucose-insulin-potassium infusion in acute myocardial infarction: a hemodynamic study. Am Heart J 2006; 51: 345-51.
Khoury VK, Haluska B, Prins J, Marwick: Effects of glucose-insulin-potassium infusion on chronic ischaemic left ventricular dysfunction. Heart 2003; 89: 61-65.
Yetkin E, Senen K, Ileri M, Atak R, Tandogan I, Yetkin O, et al: Comparison of low-dose dobutamina stress echocardiography and exhocardiograpy during glucose-insulin-potassium infusion for detection of myocardial viability after anterior myocardial infarction. Coron Art Dis 2002; 13; 145-149.
Yetkin E, Senen K, Ileri M, Atak R, Tandogan I, Yetkin O, et al: Identification of viable myocardium in patients with chronic coronary artery disease and myocardial dysfunction: comparison of low-dose-dobutamine stress echocardiography and echocardiography during glucose-insuline-potassium infusion. Angiology 2002; 53: 671-676.
Ferranti S, Gauvreau K, Hickey P, Jonas R, Wypij D, Plessi A, et al: Intraoperative hyperglycemia during infant cardiac surgery is not associate with adverse neurodevelopmental autcomes a 1,4, and 8 years. Anesthesiology 2004; 100: 1345-52.
Sodi-Pallares D, Testelli M, Fisleder BL, Bisteni A, Medrano GA, de Micheli A: Effects of an intravenous infusion of potassium glucose-insulin solution on the electrocadiographic signs of myocardial infarction. Am J Cardiol 1962; 9: 166-181.
>Archivos de Cardiología de México
>Year 2006, Issue S4