ABSTRACT Background: Sodi-Pallares and colleagues first time introduced use of glucose-insulin and potassium (GIK) solution for myocardial protection. They used this solution in patients with acute myocardial infarction and concluded that GIK solution limited electrocardiographic changes in these patients. Objective: To investigate the effectiveness of the GIK solution regarding myocardial protection evaluated by postoperative creatine kinase MB (CKMB) and cardiac troponin I levels. Method: In this prospective, randomized clinical trial, sixty-four patients were assigned into two groups: GIK group, in which glucose-insulin and potassium infusion were given during surgery, and non-GIK group in which only saline infusion was given during the procedure. Results: All CK-MB values were lower in the GIK group than the Non-GIK group in the postoperative period (6, 12 and 24 hours’ samples) with statistically significant results. Troponin values were lower in the GIK group versus the Non-GIK group after 6 and 12 hours with statistical significance (P < 0.001 and 0.022 respectively). Conclusion: The addition of GIK infusion throughout the operation to standard myocardial protective techniques in patients undergoing on-pump coronary artery bypass graft (CABG) surgery attenuates myocardial ischemic injury.

ABSTRACT Background: Abdominal sepsis patients suffer from profound intravascular fluid deficit due to concomitant inflammatory response and capillary leakage. It is reported that anti-inflammatory properties of sedative agents can control inflammatory cascade in many experimental septic conditions. We aimed to investigate the best sedative drug for inflammatory responses and capillary leak in patients with abdominal sepsis. Methods: In this prospective randomized study, 60 patients with abdominal sepsis who underwent abdominal surgery and required post-operative sedation and mechanical ventilation were randomized into 3 groups in a 1:1:1 ratio. Group D (sedated with dexmedetomidine), group P (sedated with propofol), and group M (sedated with midazolam). This study was held in intensive care units of Assiut University Hospitals with primary outcome was serum IL-6 and IL-1β. Secondary outcomes were capillary leak index, lactate clearance, vasopressor requirements, total intake, total output, and fluid balance. Results: Dexmedetomidine significantly reduced levels of IL-6 and IL-1β through 48 hours compared to both midazolam and propofol. Dexmedetomidine caused a significant decline in capillary leak index (p < 0.05) through 48 hours and significant higher lactate clearance (p = 0.03) in first 24 hours compared to both midazolam and propofol. Dexmedetomidine group had a significantly lower intake in first 24 hours and comparable vasopressor requirements through 48 hours. Dexmedetomidine group had a significantly higher output, lower serum creatinine levels and lower positive fluid balance compared to propofol and midazolam. Conclusions: Dexmedetomidine reduced inflammatory response and capillary leak in mechanically ventilated patients with abdominal sepsis with better lactate clearance and less fluid intake.

Abstract