• J Greisen and D V Nielsen.
• Department of Anaesthesiology & Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
• Acta Anaesthesiol Scand. 2013 Feb 1;57(2):171-7.

ObjectiveAssuming that high thoracic epidural analgesia (HTEA) with the sympathetic block might decrease postoperative blood glucose (BG) level and reduce the need of insulin, the aim was to evaluate the effect of HTEA on the BG level and insulin requirement in patients undergoing cardiac surgery.Materials And MethodsForty-two low-risk patients age 65-79 years scheduled for elective coronary artery bypass grafting with or without aortic valve replacement were randomised to receive HTEA as supplement for general anaesthesia. BG and lactate were measured before and after cardiopulmonary bypass and postoperatively at least every 3 h together with administration of insulin. Postoperative pain was evaluated 30 min, 2, 4 and 6 h after extubation, and before discharge from the intensive care unit.ResultsOverall BG levels showed great variation over time (P < 0.001). No statistically significant difference was found in perioperative BG, but postoperative lower BG levels were found in HTEA patients (P = 0.042). The number of patients not receiving insulin in postoperative period was significantly higher in HTEA group (9 vs. 2, P = 0.032). No differences were seen in lactate levels. Patients in the HTEA group had significant lower pain scores (P < 0.001).ConclusionHTEA preserves glucose metabolism better and leads to a lesser degree of 'stress hyperglycaemia' in cardiac surgery patients.© 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

39 keywords...

hide…