The effects of esmolol and magnesium on blood glucose regulation and hemodynamic parameters in the cases with type 2 diabetes mellitus undergoing CABG surgery

8. SUMMARYThe Effects of Esmolol and Magnesium on Blood Glucose Regulation andHemodynamic Parameters in the Cases with Type 2 Diabetes Mellitus UndergoingCABG SurgeryAim: In this study, it was aimed to search the effects of the usage of esmolol ormagnesium sulphate with GIK on the hemodynamic parameters and blood glucoseregulation in the cardiac surgery of the cases with type 2 DM.Materials and methods: The study includes 45 type 2 DM patients who underwentCABG surgery were included. These cases were randomly divided into three groups ascontrol (Group I, n=15), esmolol (Brevibloc, Baxter) (Group II, n=15) and magnesium(magnesium sulphate % 15, Biosel) (Grup III, n=15). Just after the cases entered to theoperation room their blood glucose levels were established pre-operatively and GIKinfusion was applied at the velocity of 30 ml/h prior to the induction. During the wholeoperation blood glucose levels were controlled on the determined periods (baseline (t0),pre-cannulation (t1), 5. minute in CPB (t2), end of CPB (t3), the exit of CPB-afterprotamine infusion (t4), the end of operation (t5), postoperative 6. hour (t6), postoperative12. hour (t7), postoperative 18. hour (t8) and GIK infusion was regulated according tothe protocol.In all cases, before beginning to induction, following EKG and pulse-oxymetermonitorization (Drager PM 8040 -CATO Lübeck, Holland), vena basilica cannulationwas acccomplished over both arms with 16 G catheter after. Applying local anesthesiawith %1 lidocaine, left radial artery cannulation, with 20 G cathetery and pulmonaryartery monitarization from right internal jugular vein were achieved and monitorizated.HR, MAP, CVP, MPAP, PCWP, CI, SVRI, PVRI, values were determined beforeinduction (to), after induction (t1), 30 sec. after entubation (t2), after incision (t3), afteropening the thorax (t4), after off pump protamine (t5), at the end of the operation (t6),postoperative 6. hour (t7), postoperative 12. hour (t8), postoperative 18. hour (t9).Results: The groups were no different in terms of demographic characteristics andechocardiographic results. Regarding hemodynamic changes, decreases in HR, MAPand MPAP were observed more significant by using esmolol although this reduction isobserved in the other two group, too. There was no reduction in the consumption ofGIK solution both intra-operatively and totally in esmolol and magnesium groups.38These reductions were observed more significant when esmolol is used. At the sametime, the decrease in the amounts of fentanyl and midazolam that was used intraoperativelywas determined, in esmolol and magnesium groups.Conclusion: As a result, the usage of esmolol and magnesium in coronary arterysurgery of the patients with type 2 DM; decreased the amount of GIK that is used toregulate blood glucose levels. It also decreased the amount of fentayl and midazolamthat are used to achieve hemodynamic stability and for the need of anesthesia. Thesereductions were determined more significantly by the usage of esmolol.Keywords: Diabetes Mellitus, CABG, Esmolol, Magnesium