To Assess the Impact of Glucose, Insulin, and Potassium Chloride Infusions in Patients after Cardiothoracic Surgery on Arrhythmias and Outcome
Authors: Tharra Lakshminarayana , Parveen Nadira , Dikshit Vijay , Reddy K. Subba , Sirga Sudeep , Venturumilli Ravi Sankar 
Published: January 2025

Objectives:
The role of glucose, insulin, and potassium chloride (GIK) infusions on arrhythmias after cardiothoracic surgery was widely studied. Optimization of myocardial glucose uptake, ischemia damage, and arrhythmias is reduced by GIK infusion. Most of the research was conducted when GIK infusion was utilized intraoperatively. Studies done to know the impact of GIK infusions on rhythm issues after cardiothoracic surgery were contradictory, some studies showed positive results whereas other studies indicated that GIK solution usage after cardiothoracic surgery has no role in preventing arrhythmias. Therefore, the use of GIK infusion to prevent arrhythmias in patients recovering from cardiac surgery is still debatable, necessitating the completion of additional research before a conclusion can be drawn. (1) Primary objective: To determine whether GIK infusions can prevent arrhythmias after cardiac surgery. (2) Secondary objective: To know outcome parameters such as inotropic requirement, ventilatory hours, stay in Intensive Care Unit (ICU).

Material and Methods:
This is a randomized control trail including patients of both sexes aged 20–60 years, who were shifted to post-operative cardiothoracic ICU unit of Apollo Multi-specialty Hospital (Jubilee hills, Hyderabad), after undergoing cardiothoracic surgery (Coronary artery bypass graft and valve replacement or repair). The study was done from June 2023 to February 2024. Following the fulfillment of the relevant inclusion criteria, a total of 100 patients were assigned to two groups equally: The study GIK and control (non-GIK) groups through computer-based randomization. Once the patient is shifted to post-operative cardiothoracic unit after cardiac surgery, GIK infusion (40 IU/L of human actrapid and 40 meq/L potassium chloride was added to 10% dextrose solution) is given to the GIK group, with flow rate of 30 mL/h. The infusion continued for 48 h following surgery. In non-GIK group, normal saline or other intravenous fluid was started as per requirement.

Results:
The demographic characteristics of the study group (GIK group) and control group (non-GIK group) are similar. The control group was observed to have more arrhythmias compared to the study GIK group with a significant P < 0.001. The odds ratio is 0.1976 and confidence interval 95% between the two groups is 0.084–0.465. The incidence of atrial fibrillation was high among all arrhythmias in non GIK group, while the GIK group had a higher incidence of premature ventricular contractions. The non-GIK group experienced longer ionotropic support than the study group (GIK group) with significant P < 0.001. The non-GIK group had higher rates of ventilatory support requirements and increased duration of ICU stay (P = 0.002 and <0.001). Significant side effects were not observed with GIK infusion.

Conclusion:
GIK infusion after cardiac surgery helps to minimize post-operative arrhythmias and is linked to better post-operative outcomes, such as lower requirement of ionotropic support and early extubation leading to decreased length of stay in the ICU. There are no noteworthy non-cardiac problems linked to the use of GIK infusion. Therefore, we advise using GIK infusion to prevent and lessen arrhythmias in suitable patients after cardiac surgery in the ICU, thereby reducing the duration of ICU stay.