Infusions of solutions containing Glucose-Insulin-Potassium (GIK) have been shown to positively affect myocardium and potentially benefit clinical outcomes of patients undergoing cardiovascular revascularization surgery. The mechanism by which GIK solutions work has been identified and the effects of the solution on other aspects of metabolism is not well studied. A careful analysis of how GIK solutions could influence perioperative morbidity and mortality has not been conducted. We propose to study the influence of GIK solutions on patients undergoing coronary artery bypass graft (CABG) surgery. Subjects will be randomized to receive either GIK or D5W solutions during surgery and during the first 24 hours post-operative period. During that period, clinical parameters will be measured to assess cardiac performance, post-operative complications, and use of hospital resources. Cardiac performance will be evaluated using hemodynamic measurements and arrhythmia incidence. Post-operative complications will be gauged by mortality, ICU and hospital length of stay (LOS), EKG changes, duration of exposure for ventilators, intra-aortic balloon pumps (IABP) and pressors. In addition, the metabolic effects of GIK will be studied. Blood samples will be obtained immediately in the pre-operative period, following anesthesia but prior to cardiopulmonary bypass, immediately during the post-operative period, and 6, 12 and 18 hours following the CABG surgery. These samples will be assayed for insulin, c-peptide, lactate, free fatty acids and triglyceride. Relationships between metabolic effects of GIK and clinical outcomes will be analyzed. By determining these relationships, we can better define the benefits and actions of GIK solutions and optimize their use.
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