Coronary artery bypass surgery maintaining glucose level: Difference between revisions

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| In BIMA [[grafting]], it is recommended to use a skeletonized harvest of [[IMA]].
| In BIMA [[grafting]], it is recommended to use a skeletonized harvest of [[IMA]].
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===2022 ACA Revascularization Guideline===
===2021 ACA Revascularization Guideline===
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Revision as of 05:38, 21 October 2022

Coronary Artery Bypass Surgery Microchapters

Home

Patient Information

Overview

Pathophysiology

Saphenous Vein Graft Disease
Other Non-Atherosclerotic Saphenous Vein Graft Diseases

Indications for CABG

Prognosis

Diagnosis

Imaging in the Patient Undergoing CABG

Chest X Ray

Angiography

CT Angiography
MRI Angiography

Trans-Esophageal Echocardiography

Treatment

Goals of Treatment

Perioperative Management

Perioperative Monitoring

Electrocardiographic Monitoring
Pulmonary Artery Catheterization
Central Nervous System Monitoring

Surgical Procedure

Anesthetic Considerations
Intervention in left main coronary artery disease
The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)
Minimally Invasive CABG
Hybrid coronary revascularization
Conduits Used for Bypass
Videos on Spahenous Vein Graft Harvesting
Videos on Coronary Artery Bypass Surgery

Post-Operative Care and Complications

Pharmacotherapy in patients undergoing CABG CABG

Special Scenarios

Anomalous Coronary Arteries
COPD/Respiratory Insufficiency
Existing Renal Disease
Concomitant Valvular Disease
Previous Cardiac Surgery
Menopause
Carotid Disease evaluation before surgery

Coronary artery bypass surgery maintaining glucose level On the Web

Most recent articles

Most cited articles

Review articles

CME programs

powerpoint slides

Images

Ongoing trials at clinical trials.gov

US National guidelines clearinghouse

NICE guidance

FDA on Coronary artery bypass surgery maintaining glucose level

CDC on Coronary artery bypass surgery maintaining glucose level

Coronary artery bypass surgery maintaining glucose level in the news

Blogs on Coronary artery bypass surgery maintaining glucose level|-

Directions to Hospitals Performing Coronary artery bypass surgery maintaining glucose level

Risk calculators for Coronary artery bypass surgery maintaining glucose level

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Anahita Deylamsalehi, M.D.[2] Varun Kumar, M.B.B.S. [3]

Overview

Maintaining Glucose Level in CABG

Prophylactic antibiotics is recommended, nevertheless it should not be continued beyond 48 hours.
The dose of prophylactic antibiotics must be tailored for lengthy procedures (more than two half-lives) or for those who lost excessive amount of blood during CABG.
Nasal swab test for Staphylococcus aureus is recommended.
For known carriers of Staphylococcus aureus, mupirocin 2% ointment should be applied.
For those with unknown nasal culture or PCR, preoperative intranasal mupirocin 2% ointment should be applied.
It is recommended to measure HbA1c before CABG
If it is a nonemergent surgical coronary revascularization, all extrathoracic infections must be treated before the surgery.
Guide patients to smoking cessation before elective CABG
For procedures involving a median sternotomy, it is recommended to apply topical antibiotics (vancomycin) to the cut edges of the sternum on opening and before closing.
In BIMA grafting, it is recommended to use a skeletonized harvest of IMA.

2021 ACA Revascularization Guideline

Class 1 Recommendation, Level of Evidence: B-R [19][4][5][6][11][9][10]
1. In order to reduce sternal wound infection in patients undergoing CABG an intraoperative continuous infusion of insulin should be initiated with the goal to keep blood sugar lower than 180 mg/dL.

2. In order to reduce sternal wound infection in patients undergoing CABG, an postoperative continuous infusion of insulin is recommended with the goal to keep an early postoperative blood sugar lower than 180 mg/dL.

Class 1 Recommendation, Level of Evidence: B-NR [19][12][13][14][15][20][21]
A comprehensive approach to decrease the risk of sternal wound infection is recommended in patients undergoing CABG.
Class 2b Recommendation, Level of Evidence: B-R[19][11]
The effectiveness of intraoperative continuous infusion of insulin with the goal to keep blood sugar lower than 140 mg/dL in patients undergoing CABG is not certain.

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[22]

Class I
"1. Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding hypoglycemia is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.[9][23][24] (Level of Evidence: B)"
Class IIb
"1. The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.[25][26][27] (Level of Evidence: B)"

References

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  14. 14.0 14.1 Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S (2016). "Prevention and management of sternal wound infections". J Thorac Cardiovasc Surg. 152 (4): 962–72. doi:10.1016/j.jtcvs.2016.01.060. PMID 27555340.
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  17. Cardona S, Pasquel FJ, Fayfman M, Peng L, Jacobs S, Vellanki P; et al. (2017). "Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy". J Diabetes Complications. 31 (4): 742–747. doi:10.1016/j.jdiacomp.2017.01.003. PMID 28161384.
  18. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 124 (23): 2610–42. doi:10.1161/CIR.0b013e31823b5fee. PMID 22064600.
  19. 19.0 19.1 19.2 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).
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  21. Kieser TM, Rose MS, Aluthman U, Montgomery M, Louie T, Belenkie I (2014). "Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients". J Thorac Cardiovasc Surg. 148 (5): 1887–95. doi:10.1016/j.jtcvs.2014.02.022. PMID 24613159.
  22. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
  23. Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G (2006). "Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life". European Heart Journal. 27 (22): 2716–24. doi:10.1093/eurheartj/ehi855. PMID 16608860. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  24. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R (2001). "Intensive insulin therapy in the critically ill patients". The New England Journal of Medicine. 345 (19): 1359–67. doi:10.1056/NEJMoa011300. PMID 11794168. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  25. Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH (2005). "Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting". The Journal of Thoracic and Cardiovascular Surgery. 130 (5): 1319. doi:10.1016/j.jtcvs.2005.02.049. PMID 16256784. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  26. Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG (2010). "Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery". Anesthesiology. 112 (4): 860–71. doi:10.1097/ALN.0b013e3181d3d4b4. PMID 20216389. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  27. Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM (2007). "Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial". Annals of Internal Medicine. 146 (4): 233–43. PMID 17310047. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

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