Glucose metabolism and insulin activity during cardiac surgery.

Disorders of glucose metabolism were investigated in 177 patients undergoing cardiac surgery. In group I patients, the cardiopulmonary bypass (CPB) priming fluid contained glucose. Patients in group II received neither glucose nor insulin during the operation. Group III received insulin-glucose therapy (IGT) during the operation (insulin, 1 U/kg/h, glucose, 0.5 g/kg/h). At the onset of CPB in group I, hyperglycemia was produced by the glucose load and by a relative reduction in insulin secretion. In group II, the start of the operation was accompanied by a rise in the titer of insulin antibodies. IGT resulted in normalization of the blood glucose level after CPB and stability of the insulin antibody titer during the investigation. The indices of myocardial contractility in group III were better than those of the "glucose-free" group II before and after CPB. In group II, indices of beta-cell function were moderately depressed 16 to 18 hours after the operation. Insulin and c-peptide level measurements demonstrated insulin production in group III on the first postoperative day. The results demonstrate that IGT has some potential benefit for glucose metabolism and myocardial function during cardiac surgery.

[Impairment of glucose metabolism and changes in insulin activity during open heart surgery]. / Narushenie metabolizma gliukozy i izmenenie aktivnosti insulina pri operatsiiakh na otkrytom serdtse.

The examination of 147 surgical patients with cardiac diseases revealed that the onset of an operative intervention (skin incision) was accompanied with a substantial rise in endogenous insulin antibody titers in the blood of the operated patients, which is likely to trigger glucose metabolic disturbances. Insulin, 0.8-1.0 U/(kg/hour), and glucose, 0.4-0.5 g/(kg/hour), therapy (IGT) initiated prior to the skin incision and continued up to the application of forceps to the aorta was found to prevent the increase in insulin antibody titers both during the surgery and within 16-18 hours of the nearest postoperative period. IGT was demonstrated to improve myocardial contractility of patients in the preperfusion period and to provide an additional protection of the heart during its temporary anoxia. Insulin synthetic processes were activated in the nearest postoperative period in patients receiving IGT, unlike patients from the control group, the latter showing signs of diminished functional activity of B cells in the pancreas along with a moderate enhancement in the titer of antibodies to endogenous insulin. It was concluded that intraoperative IGT is a pathogenetically substantiated therapeutic modality in the complex of anesthetic supply during open heart surgeries.

[Effect of transcutaneous transcerebral electrostimulation as electroanesthesia on the beta-endorphin content of the cerebrospinal fluid and blood plasma]. / Vliianie chreskozhnoi transtserebral'noi élektrostimuliatsii v rezhime élektroanestezii na soderzhanie beta-éndorfina v spinnomozgovoi zhidkosti i plazme krovi.

The beta-endorphin content was measured in the cerebrospinal fluid (CSF) and blood plasma of patients before and after 30 minutes of transcutaneous transcerebral electric stimulation in the electric anesthesia mode. The output current was biphasic and rectangular. It was composed of high-frequency pulse trains (peak-to-peak intensity 250-300 mA, frequency 167 kHz) modulated by low frequency (77 Hz). Electrical stimulation resulted in an appreciable increase in the beta-endorphin content in the CSF and blood plasma of patients. The data obtained attest to the intensification of the neuromodulator release to the CSF and blood plasma and to the involvement of the endorphinergic brain systems in the realization of the analgetic effect of transcutaneous transcerebral electric stimulation.