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BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days). A p-value of <0.05 was considered significant. RESULTS: The anthropometric and clinical characteristics of the patients from each group were similar, except for weight and body mass index. The mean glucose level during the protocol period was 126.69 mg/dl in the treated group and 168.21 mg/dl in the control group (p<0.0016). There were no differences between groups regarding clinical outcomes, including the duration of mechanical ventilation, length of stay in the intensive care unit, blood transfusion, postoperative infection, hypoglycemic event, neurological dysfunction or 30-day mortality (p>0.05). CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.

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BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days). A p-value of <0.05 was considered significant. RESULTS: The anthropometric and clinical characteristics of the patients from each group were similar, except for weight and body mass index. The mean glucose level during the protocol period was 126.69 mg/dl in the treated group and 168.21 mg/dl in the control group (p<0.0016). There were no differences between groups regarding clinical outcomes, including the duration of mechanical ventilation, length of stay in the intensive care unit, blood transfusion, postoperative infection, hypoglycemic event, neurological dysfunction or 30-day mortality (p>0.05). CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily...

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O estresse cirúrgico e a circulação extracorpórea causam hiperglicemia; o tratamento desta, semelhante em cirurgias e pacientes críticos, tem impacto no prognóstico clínico. Comparou-se dois regimes de glicemia: 80-120 versus menor que 200mg/dl, através de insulina continua. Foi um estudo prospectivo em 98 pacientes com medidas de glicemia na cirurgia e terapia intensiva (UTI) por 48 hs. A antropometria, característica clínica e intraoperatória foram iguais. Nos resultados não houve diferença no tempo de intubação, permanência em UTI, insuficiência renal, disfunção neurológica e mortalidade; porém, no grupo intensivo houve tendência à menor tempo de hospitalização e infecção e nos não diabéticos desse grupo a quantidade de antifibrinolíticos usados foi menor, apesar da mesma quantidade de sangue dada / Surgery and cardiopulmonary bypass leads to hyperglycemia; treating it in surgeries and critically ills has impact in their clinical prognosis. The study compared two types of glucose control: 80-120 versus less than 200mg/dl, through continuous insulin infusion. It was a prospective trial in 98 patients with glucose control in surgery and at intensive care unit (ICU) for 48 hours. Anthropometric, clinical characteristics and in surgery data were comparables. No differences were found concerning time of ventilatory support, ICU stay, acute renal failure, neurological dysfunction and mortality. There were in the intensive regimen, tendency of lesser length of stay in hospital and infection; non-diabetic patients in this group used less antifibrinolytics, even though the same number of red-cell transfusions...

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Justificativa e objetivos - Desde o primeiro relato de óbito por anestesia, muitas tentativas têm sido feitas para estudar a incidência de fatores de risco, complicações e mortalidades associadas à anestesia e cirurgia. O risco estimado periðoperatório de mortalidade varia de 0,05 a 10 acasos para 10.000 anestesias. O objetivo deste estudo foi reportar a incidência de óbitos anestésicosðcirúrgicos nas primeiras 24 horas, ocorridos no Hospital das Clínicas da FMUSP. Método - Foram revisados os prontuários de pacientes anestesiados nos anos 1998 e 1999, num total de 82.641 cirurgias. Os óbitos foram classificados quanto à causa de óbito pela classificação de Edwards, faixa etária, sexo, estado físico (ASA), especialidade e tipo de anestesia. Resultados - A causa de óbito pela classificação de Edwards demonstrou que 91,04 por cento eram da categoria V; 3,77 por cento da categoria VI; 2,13 por cento da VII; 2,84 por cento da IV e 0,23 por cento da I. A faixa etária acima de 65 anos teve incidência de óbito de 1,48 por cento; a dos adultos de 0,48 por cento; crianças de 1 a 12 anos de 0,11 por cento; crianças de 31 dias a 1 ano de 1,29 por cento e neonatos até 30 dias de 2,88 por cento. A proporção de óbitos em relação ao total é de 59,2 por cento de adultos; 30,2 por cento acima de 65 anos; 2,8 por cento de 1 a 12 anos; 4 por cento de 31 dias a 1 ano e 3,8 por cento de neonatos. Os homens representam 66,3 por cento e as mulheres 33,7 por cento dos óbitos. A distribuição por ASA foi a seguinte: ASA I ð 11,1 po cento, ASA II ð 5,2 por cento, ASA III - 30,9 por cento, ASA IV ð 34,4 por cento e ASA V ð 18,4 por cento. Cirurgias de emergência contabilizaram 67,2 por cento dos óbitos e as eletivas 32,8. A incidência geral de óbitos foi de 0,51 (sendo 1,88 por cento, a mais elevada, em cirurgia cardíaca, e 1,87 por cento em vascular). Conclusões - Os óbitos anestésicosðcirúrgicos nos anos 1998 e 1999 foram considerados inevitáveis, considerando-se a classificação de Edwards. A incidência mais alta de óbitos ocorreu em neonatos. O predomínio dos óbitos foi do sexo masculino, de pacientes ASA III ou mais, em cirurgias de emergência, cardíacas ou vasculares

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BACKGROUND AND OBJECTIVES: Since the first reported anesthetic death, many attempts have been made to study the incidence of risk factors, complications and mortality associated to anesthesia and surgery. The estimated perioperative mortality risk varies from 0.05 to 10 cases per 10,000 anesthesias. This study aimed at reporting the incidence of anesthetic-surgical death in the first 24 hours, at our hospital. METHODS: Charts had been reviewed from 82,641 surgeries performed in 1998 and 1999. Deaths were analyzed according to Edwards classification, and by age, gender, physical status, (ASA), type of surgery and anesthesia. RESULTS: Cause of the deaths according to Edwards classification has shown that 91.04% were class V, 3.77% class VI, 2.13% class VII, 2.84% class IV and 0.23% were class I. Age above 65 years accounted for 1.48% of deaths; adults incidence was 0.48%; the incidence in children aged 1 to 12 years was 0.11%; in children aged 31 days to 1 year it was 1.29% and in neonates up to 30 days of life the incidence was 2.88%. Death ratio as compared to total deaths was 59.2% in adults, 30.2% in patients above 65 years of age, 2.8% at the age 1 to 12, 4% in patients with 31 days of life to 1 year and 3.8% in newborn babies. Males represented 66.3% of deaths and females 33.7%. The distribution by ASA physical status was: ASA I - 11.1%, ASA II - 5.2%, ASA III - 30.9%, ASA IV - 34.4% and ASA V - 18.4%. Emergency surgeries accounted for 67.2% of deaths and elective surgeries for 32.8%. General incidence of the deaths was 0.51% being the highest in cardiac (1.88%) and vascular (1.87%) surgeries. CONCLUSIONS: Anesthetic-surgical deaths in the years 1998 and 1999 were considered inevitable according to Edwards classification. The highest incidence of deaths was in neonates. Most deaths occurred in males, ASA III or above patients, and emergency vascular or cardiac surgeries.