Cardioprotection with glucose insulin potassium (GIK) during non cardiac surgery in a patient with stress induced myocardial ischemia: A case report

Abstract

The administration of glucose-insulin-potassium (GIK) has demonstrated cardioprotective effects in cardiac surgery. A 58-year-old male with severe disabling back pain due to posterolateral lumbar pseudarthrosis was scheduled for spine surgery. He previously experienced two episodes of acute coronary syndrome that required percutaneous coronary interventions (PCIs). Coronary angiogram showed intrastent occlusions and multiple coronary lesions that were not suitable for percutaneous or surgical revascularization. During pharmacological stress imaging, myocardial ischemia developed in 19% of the ventricular mass and was reduced to 7% when GIK was administered. After anesthesia induction, the GIK solution was also infused and surgery was uneventful, with no signs of postoperative myocardial injury. Four days later, the patient was successfully discharged to a rehabilitation center. This is the first clinical report of GIK pretreatment during non-cardiac surgery in a patient with ischemic heart disease (IHD).

Keywords: Coronary artery disease; general anesthesia; myocardial infarct; postoperative complication.

Figure 1

Coronary angiogram showing intrastent occlusion in the left descending artery (Figure 1a, arrow) and 70% stenosis in the stent in the posterior interventricular artery (Figure 1b, arrow)

Figure 2

Myocardial positron emission computed tomography showing stress-induced ischemia (purple color) in basal inferior, mid-anterior, and apical inferior ventricular segments (Figure 2a) and the effect of glucose-insulin-potassium (GIK) infusion in reducing the extent of myocardial ischemia