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SAN FRANCISCO — Giving intraoperative insulin to cardiac surgery patients was associated with a small but significant reduction in the risk of postoperative new-onset atrial fibrillation, Dr. Michel R. Rheault said at the annual meeting of the American Society of Anesthesiologists.
The retrospective study of 9,399 patients analyzed data on all adults undergoing coronary bypass grafting or valvular procedures between January 2002 and September 2006 at the Cleveland Clinic. Of those, 5,924 had received intraoperative insulin and the rest did not. Postoperative atrial fibrillation developed in 37% of the insulin group and in 38% of the control group, reported Dr. Rheault and his associates at the clinic.
After adjusting for 44 confounding variables related to comorbid conditions, preoperative medications, operative procedures, perioperative factors, and laboratory variables, intraoperative insulin was associated with a 14% reduced risk for atrial fibrillation.
New-onset atrial fibrillation is common after cardiac surgery. Recent evidence suggesting that the inflammatory response to cardiac surgery contributes to the development of postoperative atrial fibrillation has led some surgeons to give insulin intraoperatively for its anti-inflammatory and cardioprotective effects, said Dr. Rheault.
Other changes in risk patterns were also found in the retrospective study. Patients who previously had cardiac surgery were 28% less likely to develop postoperative atrial fibrillation, whereas those undergoing a left internal thoracic artery graft had a 21% reduced risk for atrial fibrillation after surgery, compared with those undergoing other cardiac procedures.
The risk increased by 149% in patients with a history of atrial fibrillation, by 66% with every extra 10 years of age, by 28% in patients with stroke, and by 23% in patients with either cardiogenic shock or chronic obstructive pulmonary disease. The risk of postoperative atrial fibrillation was 22% higher in patients who took ?-blockers preoperatively, 19% higher in males than in females, 17% higher in patients with a history of heart failure, and 12% higher with every 5% increase in the baseline hematocrit.
The risk for postoperative atrial fibrillation was found to be 113% higher in those undergoing mitral valve replacement, 32% higher in tricuspid valvuloplasty patients, and 17% higher in those having aortic valve replacement, compared with other cardiac procedures.
The risk of postoperative atrial fibrillation increased by 27% with every unit of red blood cells transfused and by 3% with every 10-minute increase in total cross-clamp time.
SAN FRANCISCO — Giving intraoperative insulin to cardiac surgery patients was associated with a small but significant reduction in the risk of postoperative new-onset atrial fibrillation, Dr. Michel R. Rheault said at the annual meeting of the American Society of Anesthesiologists.
The retrospective study of 9,399 patients analyzed data on all adults undergoing coronary bypass grafting or valvular procedures between January 2002 and September 2006 at the Cleveland Clinic. Of those, 5,924 had received intraoperative insulin and the rest did not. Postoperative atrial fibrillation developed in 37% of the insulin group and in 38% of the control group, reported Dr. Rheault and his associates at the clinic.
After adjusting for 44 confounding variables related to comorbid conditions, preoperative medications, operative procedures, perioperative factors, and laboratory variables, intraoperative insulin was associated with a 14% reduced risk for atrial fibrillation.
New-onset atrial fibrillation is common after cardiac surgery. Recent evidence suggesting that the inflammatory response to cardiac surgery contributes to the development of postoperative atrial fibrillation has led some surgeons to give insulin intraoperatively for its anti-inflammatory and cardioprotective effects, said Dr. Rheault.
Other changes in risk patterns were also found in the retrospective study. Patients who previously had cardiac surgery were 28% less likely to develop postoperative atrial fibrillation, whereas those undergoing a left internal thoracic artery graft had a 21% reduced risk for atrial fibrillation after surgery, compared with those undergoing other cardiac procedures.
The risk increased by 149% in patients with a history of atrial fibrillation, by 66% with every extra 10 years of age, by 28% in patients with stroke, and by 23% in patients with either cardiogenic shock or chronic obstructive pulmonary disease. The risk of postoperative atrial fibrillation was 22% higher in patients who took ?-blockers preoperatively, 19% higher in males than in females, 17% higher in patients with a history of heart failure, and 12% higher with every 5% increase in the baseline hematocrit.
The risk for postoperative atrial fibrillation was found to be 113% higher in those undergoing mitral valve replacement, 32% higher in tricuspid valvuloplasty patients, and 17% higher in those having aortic valve replacement, compared with other cardiac procedures.
The risk of postoperative atrial fibrillation increased by 27% with every unit of red blood cells transfused and by 3% with every 10-minute increase in total cross-clamp time.
SAN FRANCISCO — Giving intraoperative insulin to cardiac surgery patients was associated with a small but significant reduction in the risk of postoperative new-onset atrial fibrillation, Dr. Michel R. Rheault said at the annual meeting of the American Society of Anesthesiologists.
The retrospective study of 9,399 patients analyzed data on all adults undergoing coronary bypass grafting or valvular procedures between January 2002 and September 2006 at the Cleveland Clinic. Of those, 5,924 had received intraoperative insulin and the rest did not. Postoperative atrial fibrillation developed in 37% of the insulin group and in 38% of the control group, reported Dr. Rheault and his associates at the clinic.
After adjusting for 44 confounding variables related to comorbid conditions, preoperative medications, operative procedures, perioperative factors, and laboratory variables, intraoperative insulin was associated with a 14% reduced risk for atrial fibrillation.
New-onset atrial fibrillation is common after cardiac surgery. Recent evidence suggesting that the inflammatory response to cardiac surgery contributes to the development of postoperative atrial fibrillation has led some surgeons to give insulin intraoperatively for its anti-inflammatory and cardioprotective effects, said Dr. Rheault.
Other changes in risk patterns were also found in the retrospective study. Patients who previously had cardiac surgery were 28% less likely to develop postoperative atrial fibrillation, whereas those undergoing a left internal thoracic artery graft had a 21% reduced risk for atrial fibrillation after surgery, compared with those undergoing other cardiac procedures.
The risk increased by 149% in patients with a history of atrial fibrillation, by 66% with every extra 10 years of age, by 28% in patients with stroke, and by 23% in patients with either cardiogenic shock or chronic obstructive pulmonary disease. The risk of postoperative atrial fibrillation was 22% higher in patients who took ?-blockers preoperatively, 19% higher in males than in females, 17% higher in patients with a history of heart failure, and 12% higher with every 5% increase in the baseline hematocrit.
The risk for postoperative atrial fibrillation was found to be 113% higher in those undergoing mitral valve replacement, 32% higher in tricuspid valvuloplasty patients, and 17% higher in those having aortic valve replacement, compared with other cardiac procedures.
The risk of postoperative atrial fibrillation increased by 27% with every unit of red blood cells transfused and by 3% with every 10-minute increase in total cross-clamp time.