• Hisham Hosny, Mohamed Ibrahim, Wael El-Siory, and Amr Abdel-Monem.
• Department of Anesthesia and Intensive Care, Kasr Al-Ainy Faculty of Medicine, Cairo University; Department of Cardiothoracic Anaesthesia, Royal Brompton Hospital, London, United Kingdom. Electronic address: hishamhosny@kasralainy.edu.eg.
• J. Cardiothorac. Vasc. Anesth. 2018 Jun 1; 32 (3): 1248-1253.

ObjectivesPostoperative insulin resistance represents a major component of postoperative metabolic disorder. The authors compared the effects of preoperative infusion of lipid emulsion or carbohydrate to conventional preoperative fasting on postoperative insulin and free fatty acid (FFA) levels.DesignA prospective randomized double-blinded study.SettingsTertiary university hospital.ParticipantsSixty-three patients undergoing coronary artery bypass grafting.InterventionParticipants were randomized into 3 equal groups. Group G received 500 mL of glucose 10% (50 g glucose). Group L received 100 mL of 2% lipid emulsion (soybean 30%, medium chain triglycerides (TG) 30%, olive oil 25%, fish oil 15%, and 20 mg vitamin E). Group C fasted overnight except for clear fluids allowed until 4 hours preoperatively. Serum insulin at the start of infusion (T1), 1-hour preinduction (T2), on admission to the intensive care unit (T3), after 24 hours of admission (T4), and after 48 hours of admission (T5), and FFA at T1 and T2 were measured. Serum very-low-density lipoprotein (VLDL), serum TG, and blood sugar were all measured (T1-T4). Bypass time, ischemic time, need for inotropic support, and length of intensive care unit stay also were measured.Measurements And Main ResultsAt the end of infusion FFAs were significantly lower in the L group (1.1 ± 0.76 mg/dL) compared with G (1.64 ± 0.85 mg/dL) and C groups (1.48 ± 0.76 mg/dL). Insulin levels were significantly lower in the L group compared with levels in the G and C groups at T2, T3, and T4. Also, TG, VLDL, and random blood sugar levels decreased significantly at T2, T3, and T4 in the L group compared with the other 2 groups and compared with baseline value within the same group.ConclusionPreoperative lipid infusion lowered postoperative FFA, insulin, TG, VLDL, and random blood sugar in obese patients undergoing coronary artery bypass grafting surgeries.Copyright © 2017 Elsevier Inc. All rights reserved.

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