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Insulin resistance after cardiopulmonary bypass in the elderly patient
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. (Anaesthesiology and Intensive Care)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Clinical Chemistry)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2007 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 41, no 2, 102-108 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. Preoperative carbohydrate administration attenuates insulin resistance. We studied effects of preoperative oral carbohydrate loading in elderly patients undergoing coronary artery bypass grafting. Design. Eighteen patients were assigned either to get a carbohydrate drink or to be controls. Perioperatively, glucose was administered. A gastric emptying test was performed. Glucose and insulin concentrations were measured. Levels of glucose, insulin and stress hormones were studied pre-, per- and postoperatively. Results and discussion. Preoperative carbohydrate loading did not affect stress hormones. Gastric residual after the carbohydrate drink was 11±3% (mean±SEM). Glucose concentration was lower before anaesthesia induction in the carbohydrate group, possibly due to increased insulin release. Insulin levels differed at baseline, induction and day six. All patients returned to baseline on day six. Conclusions. The study group was insulin resistant on postoperative day one and two. The effects were explainable by the traumatic stress response. No adverse effect was noted from the carbohydrate drink. If glucose is administered intravenously during surgery, there is no obvious advantage of preoperative carbohydrate loading on insulin resistance or stress hormone response.

Place, publisher, year, edition, pages
2007. Vol. 41, no 2, 102-108 p.
Keyword [en]
Insulin resistance, cardiac surgery, CABG, nutrition, gastric emptying, elderly, carbohydrate loading
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-95643DOI: 10.1080/14017430601050355ISI: 000246304200007PubMedID: 17454835OAI: oai:DiVA.org:uu-95643DiVA: diva2:169942
Available from: 2007-03-29 Created: 2007-03-29 Last updated: 2011-02-01Bibliographically approved
In thesis
1. Nutrition in Elderly Patients Undergoing Cardiac Surgery
Open this publication in new window or tab >>Nutrition in Elderly Patients Undergoing Cardiac Surgery
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many elderly undergo cardiac surgery. The prevalence of malnutrition in elderly is high and increases with comorbidity. This thesis aims to clarify some aspects on performing surgery in elderly concerning nutritional status, nutritional treatment and age-related physiology.

Study I: 886 patients were assessed preoperatively by body mass index (BMI) and S-albumin and postoperatively for mortality and morbidity.. Low BMI increased the relative hazard for death and low S-albumin increased the risk for infection. BMI and S-albumin are useful in preoperative evaluations

Study II: we followed energy intake in 31 patients for five postoperative days. Scheduled and unscheduled surgery did not differ in preoperative resting energy expenditure (REE). REE increased by 10-12% postoperatively, more in unscheduled CABG. Nutritional supplementation increased total energy intake. All patients exhibited postoperative energy deficits, less prominent in the supplemented group. There were no differences in protein synthesis or muscle degradation.

Study III: in 16 patients, .we measured stress hormones and insulin resistance before surgery and for five postoperative days Patients were insulin resistant on the first two days. We saw no clearly adverse or beneficial effects of oral carbohydrate on insulin resistance or stress hormone response.

Study IV: 73 patients, with early enteral nutrition (EN), were observed until discharge or resumed oral nutrition. EN started within three days in most patients. In a minority, problems occurred (gastric residual volumes, tube dislocation, vomiting, diarrhoea, aspiration pneumonia). In the cardiothoracic ICU individually adjusted early EN is feasible.

Study V: in 16 patients, splanchnic blood flow (SBF) enhancing treatments (dopexamine (Dpx) or EN) were compared. Dpx increased systemic blood flow, but had only a transient effect on SBF. EN had no effect on systemic blood flow or SBF. Neither Dpx, EN or the combined treatment, exhibited any difference between groups on systemic or splanchnic VO2 or oxygen extraction ratio.

53 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 245
Anaesthesiology and intensive care, elderly, nutrition, CABG, cardiac surgery, outcome, insulin resistance, enteral nutrition, splanchnic blood flow, BMI, albumin, 3-methylhistidine, alfa-1-antitrypsin, Anestesiologi och intensivvård
urn:nbn:se:uu:diva-7774 (URN)978-91-554-6842-2 (ISBN)
Public defence
2007-04-20, Hedstrandsalen, Entrance 70, Akademiska sjukhuset, 75185 Uppsala, 09:15
Available from: 2007-03-29 Created: 2007-03-29Bibliographically approved

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