%0 Journal Article
%T Glycemic Control during Coronary Artery Bypass Graft Surgery
%A Harold L. Lazar
%J ISRN Cardiology
%D 2012
%R 10.5402/2012/292490
%X Hyperglycemia, which occurs in the perioperative period during cardiac surgery, has been shown to be associated with increased morbidity and mortality. The management of perioperative hyperglycemia during coronary artery bypass graft surgery and all cardiac surgical procedures has been the focus of intensive study in recent years. This report will paper the pathophysiology responsible for the detrimental effects of perioperative hyperglycemia during cardiac surgery, show how continuous insulin infusions in the perioperative period have improved outcomes, and discuss the results of trials designed to determine what level of a glycemic control is necessary to achieve optimal clinical outcomes. 1. Introduction The incidence of diabetes mellitus in patients undergoing coronary artery bypass graft (CABG) surgery continues to increase and it is now estimated that nearly 30¨C40% of CABG patients will have diabetes mellitus or the metabolic syndrome [1]. Patients with diabetes mellitus have had worse outcomes following CABG [2¨C4]. They have higher mortality and a higher incidence of renal failure, stroke, sternal wound infections, and increased need for inotropic support [5¨C8]. Their length of stay is prolonged and hospital costs are increased [9]. Furthermore, diabetic CABG patients are more likely to require a repeat revascularization procedure, have a 24% higher risk of readmission for cardiac-related issues, and a 44% higher risk for rehospitalization for any cause [10, 11]. These outcomes were thought to be irreversible since diabetic patients have more diffuse coronary disease, abnormal fibrinolytic and platelet function and impaired endothelial function which leads to lower graft patency and ultimately increased perioperative mortality, reduced long-term survival, and less freedom from recurrent ischemic events [12¨C15]. In this paper, we will show that by achieving glycemic control in patients with diabetes mellitus undergoing CABG surgery, perioperative morbidity and mortality can be reduced, long-term survival improved, and the incidence of recurrent ischemic events decreased. 2. Detrimental Effects of Hyperglycemia on the Cardiovascular System In order to understand the beneficial effects of glycemic control during CABG surgery in patients with hyperglycemia, it is important to understand the detrimental effects of hyperglycemia on the cardiovascular system. In the nonischemic myocardium, the primary energy substrate is free fatty acids [16]. However, during ischemia when free fatty acids cannot be metabolized, increased levels of free fatty acids can
%U http://www.hindawi.com/journals/isrn.cardiology/2012/292490/