Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery
Authors: Ragheb Assaly, Robert H. Habib
Journal: Annals of Internal Medicine (2007)

Letters2 October 2007Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac SurgeryRagheb Assaly, MD and Robert H. Habib, PhDRagheb Assaly, MDFrom the University of Toledo College of Medicine, Toledo, OH 43606-3390.Search for more papers by this author and Robert H. Habib, PhDFrom the University of Toledo College of Medicine, Toledo, OH 43606-3390.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-147-7-200710020-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their recent article comparing intensive intraoperative insulin therapy and conventional glucose management during cardiac surgery, Gandhi and colleagues (1) did not discuss the medications used during induction of anesthesia, specifically whether etomidate was used. This is important for 2 reasons. First, Edelman and colleagues (2) showed that etomidate administration in humans resulted in cerebral deoxygenation and enhanced hypoxic risk in the setting of cerebral ischemia. Second, the adrenal counterregulatory hormones are inhibited by etomidate, which can last 8 to 12 hours (3), and could have contributed to more morbidity—especially in the intensive insulin-treated group, where the ...References1. Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med. 2007;146:233-43. [PMID: 17310047] LinkGoogle Scholar2. Edelman GJ, Hoffman WE, Charbel FT. Cerebral hypoxia after etomidate administration and temporary cerebral artery occlusion. Anesth Analg. 1997;85:821-5. [PMID: 9322462] CrossrefMedlineGoogle Scholar3. Jackson WL. Should we use etomidate as an induction agent for endotracheal intubation in patients with septic shock?: a critical appraisal. Chest. 2005;127:1031-8. [PMID: 15764790] CrossrefMedlineGoogle Scholar4. Auer RN. Progress review: hypoglycemic brain damage. Stroke. 1986;17:699-708. [PMID: 3526646] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the University of Toledo College of Medicine, Toledo, OH 43606-3390. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIntensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery Gunjan Y. Gandhi , Gregory A. Nuttall , Martin D. Abel , Charles J. Mullany , Hartzell V. Schaff , Peter C. O'Brien , Matthew G. Johnson , Arthur R. Williams , Susanne M. Cutshall , Lisa M. Mundy , Robert A. Rizza , and M. Molly McMahon Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery Ferran Rius and Didac Mauricio Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery Gunjan Y. Gandhi , Gregory A. Nuttall , and Martin D. Abel Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery George Carvalho and Thomas Schricker Metrics Cited byAssociation of intraoperative hyperglycemia with postoperative composite infection after cardiac surgery with cardiopulmonary bypass: A retrospective cohort study 2 October 2007Volume 147, Issue 7Page: 521KeywordsAnesthesiaBloodBrainCardiac surgeryCerebral ischemiaConflicts of interestGlucoseHormonesInsulin ePublished: 2 October 2007 Issue Published: 2 October 2007 Copyright & PermissionsCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...