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Effects of thoracic epidural analgesia on glucose homeostasis after cardiac surgery in patients with and without diabetes mellitus

Published online by Cambridge University Press:  29 June 2005

R. E. Anderson ,
J. Ehrenberg ,
G. Barr ,
K. Brismar ,
A. Öwall ,
T. Alserius  and
T. Ivert
R. E. Anderson
Affiliation:
Karolinska Hospital, Department of Thoracic Surgery and Anaesthesiology, Stockholm, Sweden
J. Ehrenberg
Affiliation:
Karolinska Hospital, Department of Thoracic Surgery and Anaesthesiology, Stockholm, Sweden
G. Barr
Affiliation:
Karolinska Hospital, Department of Thoracic Surgery and Anaesthesiology, Stockholm, Sweden
K. Brismar
Affiliation:
Karolinska Hospital, Department of Endocrinology and Diabetology, Stockholm, Sweden
A. Öwall
Affiliation:
Karolinska Hospital, Department of Thoracic Surgery and Anaesthesiology, Stockholm, Sweden
T. Alserius
Affiliation:
Karolinska Hospital, Department of Thoracic Surgery and Anaesthesiology, Stockholm, Sweden
T. Ivert
Affiliation:
Karolinska Hospital, Department of Thoracic Surgery and Anaesthesiology, Stockholm, Sweden
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Extract

Summary

Background and objective: Even moderate hyperglycaemia increases mortality/morbidity after coronary artery bypass grafting, stroke and myocardial infarction. The goal of this prospective study was to determine if using thoracic epidural analgesia from start of surgery until the end of the third postoperative day would blunt postoperative hyperglycaemia. Methods: Forty-four patients had diabetes mellitus, 60 did not; half of each group had an epidural with continuous local anaesthetics. All patients received continuous insulin infusions during the initial 24 h period beginning with surgery. Blood glucose was measured four times daily (fasting or 2–3 h post-prandial) until end of the third postoperative day. Results: For patients without diabetes, the epidural group had lower mean blood glucose and insulin requirements (P < 0.02) than controls during the initial 24 h period beginning with surgery. For patients with diabetes mellitus, thoracic epidural analgesia reduced mean blood glucose (P = 0.017) with unchanged insulin requirements. Epidural did not diminish the increase (vs. preoperative) in fasting blood glucose on the third postoperative day (32% vs. 22%, P < 0.001) for non-diabetics. Epidural analgesia was not able to attenuate hyperglycaemia during the first 3 postoperative days. Conclusions: Epidural analgesia improved glucose homeostasis minimally during the initial 24 postoperative hours but did not attenuate hyperglycaemia during the subsequent 3 postoperative days.

Keywords

ANAESTHESIA EPIDURAL, thoracicDIABETES MELLITUSTHORACIC SURGERY, cardiovascularBLOOD GLUCOSEANAESTHESIA GENERAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 7 , July 2005 , pp. 524 - 529
Copyright
© 2005 European Society of Anaesthesiology

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