R. Svedjeholm et al., RATIONALE FOR METABOLIC SUPPORT WITH AMINO-ACIDS AND GLUCOSE-INSULIN-POTASSIUM (GIK) IN CARDIAC-SURGERY, The Annals of thoracic surgery, 59(2), 1995, pp. 15-22
Myocardial metabolism and the current state of metabolic intervention
under conditions relevant to cardiac surgery are reviewed. The rationa
le for metabolic support differs considerably in various settings of c
ardiac surgery. Although preventive measures are theoretically attract
ive, their use in the preoperative setting remains to be clarified. Am
ino acid enrichment of blood cardioplegia seems to be justified by an
abundance of animal experimental data. In the postoperative setting of
cardiac surgery, metabolic abnormalities may explain reversible myoca
rdial dysfunction. Further, the combined effects of ischemia and the s
ystemic neuroendocrine response to surgical trauma may adversely affec
t recovery. Amino acids, particularly glutamate, seem vital for metabo
lic recovery in this setting. Treating the relative shortage of glutam
ate occurring during this period by the administration of exogenous gl
utamate and counteracting the effects of the systemic neuroendocrine s
tress response by high-dose glucose-insulin-potassium are measures tha
t have been shown to improve the metabolic state of the heart and subs
equently myocardial performance.