>Year 2001, Issue 4
Cutler GD, Arellano UJ
Glucose, insulin, and potassium solution for the treatment of post-surgical ileus. Preliminary clinical observation
Cir Gen 2001; 23 (4)
PDF: 4. Kb.
Objective: To assess whether administration of a polarizing solution (glucose-insulin-potassium) to patients subjected to open abdominal surgery prevents or diminished the post-operative ileus.
Design: Prospective, comparative study.
Setting: Third level health care hospitals.
Patients and methods: We studied 100 patients subjected to open abdominal surgery. They were divided in two groups of 50 patients each. The study group (A) received, one hour before surgery, a solution consisting in 950 ml of 10% glucose, 50 ml of 50% glucose, 40 mEq of potassium chloride, and 20 IU of plain insulin, administered intravenously, at a dose of 40 drops/min, which was continued for one hour more after surgery. The control group (B) received only a 5% glucose solution, through the same route for 1 hour before surgery that was continued for 1 hour after surgery, at a rate of 40 drops/min. We assessed clinically the presence of intestinal noises, canalization of gases, and potassium and seric glucose through laboratory tests.
Results: In group A, peristalsis was audible between one to seven and a half hours after finishing the surgery, gas canalization through the rectum occurred between one and a half and 21 hours after surgery, these patients did not require a nasogastric catheter. In group B, intestinal noises were audible between 5 and 9 hours after surgery, and flatus were passed between 9 and 43 hours; five patients required a nasogastric catheter due to gastric distention. Potassium was found high in 11 patients from group A and depressed in six patients from group B, glycemia values were not altered in any of the groups.
Conclusion: In this clinical study, the post-operative ileus was prevented through the use of a polarizing solution.
||Polarizing solution, paralytic ileus, abdominal surgery.
Bohr DF. Electrolytes and smooth muscle contraction. Pharmacol Rev 1964; 16: 85-127.
Burnstock G, Holman ME, Prosser CL. Electrophysiology of smooth muscle. Physiol Rev 1963; 43: 482-527.
Daniel EE, Chapman KM. Electrical activity of the gastrointestinal tract as an indication of mechanical activity. Am J Dig Dis 1963; 8: 54-102.
Gillespie JS. The electrical and mechanical responses of intestinal smooth muscle cells to stimulation of their extrinsic parasympathetic nerves. J Physiol 1962; 162: 76-92.
Goodford PJ, Hermansen K. Sodium and potassium movements in the unstriated muscle of the guinea-pig Taenia coli. J Physiol (Lond) 1961; 158: 426-48.
Opie LH. Metabolic perturbations in ischemic heart disease. Dialog Cardiovasc Med 1966; 1: 75-83.
Gradinak S, Coleman GM, Taegtmeyer H, Sweeney MS, Frazier OH. Improved cardiac function with glucose-insulin-potassium after aorto coronary by grafting pass. Ann Thorac Surg 1989; 48: 484-9.
Opie LH. Glucose and the metabolism of ischaemic myocardium. Lancet 1995; 345: 1520-1.
Sodi-Pallares D, Testelli MR, Fishleder BL, Bisteni A, Medrano GA, Friedland C, et al. Effects of an intravenous infusion of a potassium-glucose-insulin solution on the electrocardiographic signs of myocardial infarction. A preliminary clinical report. Am J Cardiol 1962; 9: 166-81.
Apstein CS, Taegtemeyer H. Glucose-insulin-potassium in acute myocardial infarction: the time has come for a large, prospective trial. Circulation 1997; 96: 1074-7.
Fath-Ordoubadi F, Beatt KJ. Glucose-insulin-potassium therapy for treatment of acute myocardial infarction: an overview of randomized placebo-controlled trials. Circulation 1997; 96: 1152-6.
Basse L, Hjort Jakobsen D, Billesbolle P, Werner M, Kehlet H. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000; 232: 51-7.
Holte K, Kehlet H. Postoperative ileus: a preventable event. Br J Surg 2000; 87: 1480-93.
De Michelli A. La terapéutica metabólica con glucosa-insulina-potasio. Bosquejo histórico. Arch Inst Cardiol Mex 2000; 70: 609-15.
>Year 2001, Issue 4