Coronary artery bypass surgery maintaining glucose level

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Coronary Artery Bypass Surgery Microchapters

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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

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

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[1]

Hormonal Manipulation (DO NOT EDIT)[1]

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.[2][3][4] (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.[5][6][7] (Level of Evidence: B)"


References

  1. 1.0 1.1 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.
  2. Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A (2003). "Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting". The Journal of Thoracic and Cardiovascular Surgery. 125 (5): 1007–21. doi:10.1067/mtc.2003.181. PMID 12771873. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  3. 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)
  4. 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)
  5. 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)
  6. 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)
  7. 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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