Intraoperative Maintenance of Normoglycemia with Insulin and Glucose Preserves Verbal Learning after Cardiac Surgery

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2014
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Schricker, Thomas
Sato, Hiroaki
Beaudry, Thomas
Codere, Takumi
Hatzakorzian, Roupen
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PLoS ONE. 2014, 9(6), e99661. eISSN 1932-6203. Available under: doi: 10.1371/journal.pone.0099661
Zusammenfassung

Objective

The hyperglycemic response to surgery may be a risk factor for cognitive dysfunction. We hypothesize that strict maintenance of normoglycemia during cardiac surgery preserves postoperative cognitive function.

Methods

As part of a larger randomized, single-blind, interventional efficacy study on the effects of hyperinsulinemic glucose control in cardiac surgery (NCT00524472), consenting patients were randomly assigned to receive combined administration of insulin and glucose, titrated to preserve normoglycemia (3.5–6.1 mmol L−1; experimental group), or standard metabolic care (blood glucose 3.5–10 mmol L−1; control group), during open heart surgery. The patients’ cognitive function was assessed during three home visits, approximately two weeks before the operation, and two months and seven months after surgery. The following tests were performed: Rey Auditory Verbal Learning Task (RAVLT for verbal learning and memory), Digit Span Task (working memory), Trail Making A & B (visuomotor tracking and attention), and the Word Pair Task (implicit memory). Questionnaires measuring specific traits known to affect cognitive performance, such as self-esteem, depression, chronic stress and social support, were also administered. The primary outcome was to assess the effect of hyperinsulinemic-normoglycemic clamp therapy versus standard therapy on specific cognitive parameters in patients receiving normoglycemic clamp, or standard metabolic care.

Results

Twenty-six patients completed the study with 14 patients in the normoglycemia and 12 patients in the control group. Multiple analysis of covariance (MANCOVA) for the RAVLT showed a significant effect for the interaction of group by visit (F = 4.07, p = 0.035), and group by visit by recall (F = 2.21, p = 0.04). The differences occurred at the second and third visit. MANCOVA for the digit span task, trail making and word pair association test showed no significant effect.

Conclusions

Preserving intraoperative normoglycemia by intravenous insulin and glucose may prevent the impairment of memory function, both short and long-term, after cardiac surgery.

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ISO 690SCHRICKER, Thomas, Hiroaki SATO, Thomas BEAUDRY, Takumi CODERE, Roupen HATZAKORZIAN, Jens C. PRUESSNER, 2014. Intraoperative Maintenance of Normoglycemia with Insulin and Glucose Preserves Verbal Learning after Cardiac Surgery. In: PLoS ONE. 2014, 9(6), e99661. eISSN 1932-6203. Available under: doi: 10.1371/journal.pone.0099661
BibTex
@article{Schricker2014-06-18Intra-38711,
  year={2014},
  doi={10.1371/journal.pone.0099661},
  title={Intraoperative Maintenance of Normoglycemia with Insulin and Glucose Preserves Verbal Learning after Cardiac Surgery},
  number={6},
  volume={9},
  journal={PLoS ONE},
  author={Schricker, Thomas and Sato, Hiroaki and Beaudry, Thomas and Codere, Takumi and Hatzakorzian, Roupen and Pruessner, Jens C.},
  note={Article Number: e99661}
}
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