Abstract:
BACKGROUND:Glucose-insulin-potassium (GIK) administration during cardiac surgery inconsistently improves myocardial function, perhaps because hyperglycemia negates the beneficial effects of GIK. The hyperinsulinemic normoglycemic clamp (HNC) technique may better enhance the myocardial benefits of GIK. The authors extended previous GIK investigations by (1) targeting normoglycemia while administering a GIK infusion (HNC); (2) using improved echocardiographic measures of myocardial deformation, specifically myocardial longitudinal strain and strain rate; and (3) assessing the activation of glucose metabolic pathways. METHODS:A total of 100 patients having aortic valve replacement for aortic stenosis were randomly assigned to HNC (high-dose insulin with concomitant glucose infusion titrated to normoglycemia) versus standard therapy (insulin treatment if glucose >150 mg/dl). The primary outcomes were left ventricular longitudinal strain and strain rate, assessed using speckle-tracking echocardiography. Right atrial tissue was analyzed for activation of glycolysis/pyruvate oxidation and alternative metabolic pathways. RESULTS:Time-weighted mean glucose concentrations were lower with HNC (127 ± 19 mg/dl) than standard care (177 ± 41 mg/dl; P < 0.001). Echocardiographic data were adequate in 72 patients for strain analysis and 67 patients for strain rate analysis. HNC did not improve myocardial strain, with an HNC minus standard therapy difference of -1.2% (97.5% CI, -2.9 to 0.5%; P = 0.11). Strain rate was significantly better, but by a clinically unimportant amount: -0.16 s (-0.30 to -0.03 s; P = 0.007). There was no evidence of increased glycolytic, pyruvate oxidation, or hexosamine biosynthetic pathway activation in right atrial samples (HNC, n = 20; standard therapy, 22). CONCLUSION:Administration of glucose and insulin while targeting normoglycemia during aortic valve replacement did not meaningfully improve myocardial function.
journal_name
Anesthesiologyjournal_title
Anesthesiologyauthors
Duncan AE,Kateby Kashy B,Sarwar S,Singh A,Stenina-Adognravi O,Christoffersen S,Alfirevic A,Sale S,Yang D,Thomas JD,Gillinov M,Sessler DIdoi
10.1097/ALN.0000000000000723subject
Has Abstractpub_date
2015-08-01 00:00:00pages
272-87issue
2eissn
0003-3022issn
1528-1175pii
00000542-201508000-00014journal_volume
123pub_type
杂志文章,随机对照试验相关文献
ANESTHESIOLOGY文献大全abstract::Controversy persists about the cardiac toxicity of bupivacaine if accidentally administered intravenously during regional anesthesia. Using awake, unanesthetized sheep, we evaluated the cardiac effects of low and high equivalent doses of lidocaine and bupivacaine given intravenously over 10 s. All animals convulsed wi...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198401000-00004
更新日期:1984-01-01 00:00:00
abstract::Deliberate hypotension was induced with isoflurane (mean inspired concentration 2.3 +/- 1.0%) in 12 patients undergoing craniotomy for clipping of cerebral aneurysms. Global cerebral blood flow (CBF) was measured before, during, and after hypotension. Arterio-venous O2 content difference was measured concomitantly, an...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198603000-00001
更新日期:1986-03-01 00:00:00
abstract::The safety and efficacy of epidural morphine injected into the caudal space for control of postoperative pain following open cardiac surgery in children was studied. Thirty-two children between the ages of 2-12 yr for whom early postoperative tracheal extubation was anticipated were randomly assigned to control and st...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-198903000-00009
更新日期:1989-03-01 00:00:00
abstract:BACKGROUND:Alpha-2B adrenoceptor is the vasoconstrictive subtype in the mouse. Human alpha2B-AR deletion (D) allele has been associated with loss of short-term agonist-promoted receptor desensitization, which may lead to increased vasoconstriction on alpha2 activation. The goal of this study was to test the hypothesis ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200503000-00010
更新日期:2005-03-01 00:00:00
abstract::The occurrence of fasciculations following administration of agents is a well-known pharmacologic phenomenon. Using the cat soleus nerve-muscle preparation, intravenous neostigmine doses between 20-200 micrograms/kg evoked fasciculations in a dose-related manner. The data demonstrate that the fasciculations were the r...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198712000-00011
更新日期:1987-12-01 00:00:00
abstract:BACKGROUND:The authors developed a measure to determine whether maternal motivation to be present during induction (Motivation for Parental Presence during Induction of Anesthesia [MPPIA]) is related to children's anxiety during the induction process. METHODS:Mothers and children (aged 2-12 yr) undergoing outpatient, ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200509000-00008
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:A focal cortical cryogenic brain injury has been reported to reduce the brain pentobarbital concentrations needed to prevent movement in response to pain in rats. This occurred despite any apparent behavioral changes in the awake animals. To determine whether this was true with other anesthetics, the authors...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199307000-00020
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:Densities in dependent lung regions worsen oxygenation in patients with acute respiratory distress syndrome. Identification of these densities requires examination using computed tomography (CT). In this study, the authors evaluated the use of transesophageal echocardiography (TEE) to estimate densities in t...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200105000-00017
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:Because patients may be taking clonidine chronically or may be receiving it as a premedication before surgery, the authors investigated its effect on cerebral hemodynamics. METHODS:In nine volunteers, middle cerebral artery mean blood flow velocity (Vm) was measured using transcranial Doppler ultrasonograph...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199709000-00015
更新日期:1997-09-01 00:00:00
abstract::The authors used pharmacokinetic and pharmacodynamic modeling to explain the time course of neuromuscular blockade following single or multiple doses of three nondepolarizing muscle relaxants. Published and unpublished pharmacokinetic and pharmacodynamic data for 13 normal subjects were used to simulate the duration o...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:
更新日期:1986-09-01 00:00:00
abstract:BACKGROUND:CW002 is a neuromuscular blocking drug that is inactivated by endogenous L-cysteine. This study determined the exogenous L-cysteine dose-response relationship for CW002 reversal along with acute cardiovascular effects and organ toxicity in dogs. METHODS:Six dogs were each studied four times during isofluran...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e3181d31f8c
更新日期:2010-04-01 00:00:00
abstract:BACKGROUND:Nitrous oxide causes an acute increase in plasma homocysteine that is more pronounced in patients with the methylenetetrahydrofolate reductase (MTHFR) C677T or A1298C gene variant. In this randomized controlled trial, the authors sought to determine whether patients carrying the MTHFR C677T or A1298C variant...
journal_title:Anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/ALN.0b013e31829761e3
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:Halothane has been previously shown in vitro to decrease both the inward calcium current in isolated cells and the density of calcium antagonist binding sites in cardiac sarcolemmal membranes prepared from several species, including humans, presumably contributing to the negative inotropic effects seen with ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199411000-00015
更新日期:1994-11-01 00:00:00
abstract::The authors studied the influence of locally administered isoflurane anesthesia on the pulmonary vascular response to regional alveolar hypoxia (hypoxic pulmonary vasoconstriction [HPV]) over a range of cardiac outputs (COs) in seven mechanically ventilated, closed-chest dogs. The right lung was ventilated with 100% O...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198604000-00002
更新日期:1986-04-01 00:00:00
abstract::Critically ill patients often suffer from multiple organ failures involving lung, kidney, liver, or brain. Genomic, proteomic, and metabolomic approaches highlight common injury mechanisms leading to acute organ failure. This underlines the need to focus on therapeutic strategies affecting multiple injury pathways. Th...
journal_title:Anesthesiology
pub_type: 杂志文章,评审
doi:10.1097/ALN.0000000000000446
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:Previous attempts at improving operating room utilization have generally emphasized more accurate scheduling, starting the first case on time, and reducing turnover time. Surgical case cancellations have largely been ignored except for recommendations for preoperative screening and good physician-patient com...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200604000-00029
更新日期:2006-04-01 00:00:00
abstract:WHAT WE ALREADY KNOW ABOUT THIS TOPIC:WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Hypotension is a risk factor for adverse perioperative outcomes. Machine-learning methods allow large amounts of data for development of robust predictive analytics. The authors hypothesized that machine-learning methods can prov...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0000000000002374
更新日期:2018-10-01 00:00:00
abstract::Volatile anesthetics inhibit phagocytic cell function, yet little is known about their effects on target tissues or on the target tissue response to stimulated phagocytes. Experiments were performed to determine how exposure to halothane and isoflurane changes rat pulmonary artery endothelial cell (RPAEC) viability in...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199106000-00015
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:Intraoperative awareness in patients undergoing general anesthesia is an infrequent but well-described adverse outcome. The reported incidence of this phenomenon is between 0.1% and 0.9%. METHODS:With institutional review board approval, the authors reviewed continuous quality improvement data from 3 yr (20...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200702000-00014
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:Excitatory amino acid receptors are important for both sensory and motor function in the spinal cord. We studied the effects of intrathecal LY293558, a competitive non-N-methyl-D-aspartate excitatory amino acid receptor antagonist, on motor and sensory function in rats to determine whether drugs blocking the...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200207000-00025
更新日期:2002-07-01 00:00:00
abstract:WHAT WE ALREADY KNOW ABOUT THIS TOPIC:WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Traumatic brain injury induces cellular proliferation in the hippocampus, which generates new neurons and glial cells during recovery. This process is regulated by N-methyl-D-aspartate-type glutamate receptors, which are inhibite...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0000000000002197
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Whether the fetus can experience pain remains controversial. During the last half of pregnancy, the neuroanatomic connections for nociception are in place, and the human fetus mounts sizable stress responses to physical insults. Analgesia has been recommended for intrauterine procedures or late termination, ...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-200110000-00008
更新日期:2001-10-01 00:00:00
abstract:BACKGROUND:Norepinephrine has been investigated as a potential alterative to phenylephrine for maintaining blood pressure during spinal anesthesia for cesarean delivery with the advantage of less depression of maternal heart rate and cardiac output. However, the relative potencies of these two vasopressors have not bee...
journal_title:Anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/ALN.0000000000001880
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Substance use disorder among physicians can expose both physicians and their patients to significant risk. Data regarding the epidemiology and outcomes of physician substance use disorder are scarce but could guide policy formulation and individual treatment decisions. This article describes the incidence an...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0000000000003310
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Factors determining renal function at organ recovery in deceased kidney donors are not well established. METHODS:The authors studied the prevalence and risk factors associated with elevated prerecovery creatinine and calculated glomerular filtration rate in 458 deceased organ donors identified through the C...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e318194ca8a
更新日期:2009-02-01 00:00:00
abstract::The effect of hypocapnia on autoregulation of cerebral blood flow (CBF) and the lower limit of autoregulation (LLA) was determined in dogs anesthetized with nitrous oxide (66%) and halothane (0.2%, end-expired concentration). CBF and cerebral vascular resistance (CVR) were determined during both normocapnia and hypoca...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198902000-00018
更新日期:1989-02-01 00:00:00
abstract::The effects of increased intracranial pressure (ICP) and increased cardiac output (QT) on the pulmonary vascular response to regional alveolar hypoxia were compared in pentobarbital-anesthetized, closed-chested dogs. A bronchial divider was inserted, the right lung (RL) was continuously ventilated with 100% O2, and th...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199003000-00017
更新日期:1990-03-01 00:00:00
abstract::The serum and urinary concentrations of fluorinated metabolites of isoflurane after inhalation of three different concentrations of isoflurane were studied in 18 ASA physical status 1 or 2 patients, scheduled for orthopedic or otolaryngeal surgery. Isoflurane was administered for 60 min during fentanyl-nitrous oxide-o...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:
更新日期:1988-08-01 00:00:00
abstract:BACKGROUND:Although evidence of its effects is tentative, acupuncture has long been used in the treatment of multiple maladies. So far, it has not been possible to discriminate the effects of the venue from specific results of needling itself, thus physicians merely depend on patients' statements. The authors investiga...
journal_title:Anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/ALN.0b013e3181b31e24
更新日期:2009-09-01 00:00:00
abstract::The cerebral metabolic effects of a massive dose of thiopental (177 mg/kg) were investigated in seven dogs. The systemic circulation was supported with an extracorporeal circuit. At an infusion rate of 2 mg/kg/min, cerebral oxygen consumption (CMR(O(2))) decreased progressively until cerebral electrical silence was pr...
journal_title:Anesthesiology
pub_type: 评论,杂志文章
doi:10.1097/00000542-200210000-00036
更新日期:2002-10-01 00:00:00