Tight intraoperative blood glucose control is associated with postop delirium after cardiac surgery.

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• Leif Saager, Andra E Duncan, Jean-Pierre Yared, Brian D Hesler, Jing You, Anupa Deogaonkar, Daniel I Sessler, and Andrea Kurz.
• From the Departments of Outcomes Research (L.S., A.E.D., J.-P.Y., B.D.H., J.Y., D.I.S., A.K.), Cardiothoracic Anesthesia (A.E.D., J.-P.Y.), Quantitative Health Sciences (J.Y.), Regional Practice Anesthesiology (A.D.), and General Anesthesiology (A.K.), Cleveland Clinic, Cleveland, Ohio.
• Anesthesiology. 2015 Jun 1;122(6):1214-23.

BackgroundPostoperative delirium is common in patients recovering from cardiac surgery. Tight glucose control has been shown to reduce mortality and morbidity. Therefore, the authors sought to determine the effect of tight intraoperative glucose control using a hyperinsulinemic-normoglycemic clamp approach on postoperative delirium in patients undergoing cardiac surgery.MethodsThe authors enrolled 198 adult patients having cardiac surgery in this randomized, double-blind, single-center trial. Patients were randomly assigned to either tight intraoperative glucose control with a hyperinsulinemic-normoglycemic clamp (target blood glucose, 80 to 110 mg/dl) or standard therapy (conventional insulin administration with blood glucose target, <150 mg/dl). Delirium was assessed using a comprehensive delirium battery. The authors considered patients to have experienced postoperative delirium when Confusion Assessment Method testing was positive at any assessment. A positive Confusion Assessment Method was defined by the presence of features 1 (acute onset and fluctuating course) and 2 (inattention) and either 3 (disorganized thinking) or 4 (altered consciousness).ResultsPatients randomized to tight glucose control were more likely to be diagnosed as being delirious than those assigned to routine glucose control (26 of 93 vs. 15 of 105; relative risk, 1.89; 95% CI, 1.06 to 3.37; P = 0.03), after adjusting for preoperative usage of calcium channel blocker and American Society of Anesthesiologist physical status. Delirium severity, among patients with delirium, was comparable with each glucose management strategy.ConclusionIntraoperative hyperinsulinemic-normoglycemia augments the risk of delirium after cardiac surgery, but not its severity.

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