Abstract
Background & Aims:The aim was to study the safety and efficacy of oral carbohydrate loading in type 2 diabetics undergoing off-pump coronary artery bypass grafting (CABG).The primary objective was to evaluate the residual gastric volume and secondary objectives included evaluating insulin resistance and inotrope requirement.Group 1 (n=20)Group 2 (n=20) P MeanSDMeanSDPre op RBS135.945.1142.729.80.580Intraoperative RBS 1 (2 h)138.735.2156.527.60.084Intraoperative RBS 2 (4 h)142.626.8162.121.80.016Intraoperative RBS 3 (6 h)152.525.0169.719.60.020Post OP RBS 1 (0 h)198.531.4199.525.40.886Post OP RBS 2 (4 h)159.953.2195.217.30.008Post OP RBS 3 (8 h)168.135.5172.115.50.651Post OP RBS 4 (12 h)184.537.1157.211.50.003Post OP RBS 5 (16 h)199.542.4150.121.5<0.001Methods:This prospective, unicentric, non-blinded randomised controlled study was conducted on 40 American Society of Anesthesiologists grade III & IV subjects. The study population was randomly allocated into Control Group in which patients were given 800 ml of clear fluids on the night before surgery and 400 ml of clear fluids 2 hours before on the day of surgery and Study group in which patients were given carbohydrate drink (50 gm of two carbohydrate sachets mixed with 800 ml of water) night before surgeryand 50 gm of one carbohydrate sachet mixed with 400 ml of water 2 h before surgery.Results:Both the groups had comparable residual gastric volumes. The Carboload group had higher blood sugar levels in the preoperative and intraoperative periods. Blood sugar control was better in the Carboload group during the postoperativeperiod, and the mean total insulin requirement and lactate levels for the Carboload group were less than the clear fluid group.Patient wellbeing was significantly higher in the Carboload group. No episodes of regurgitation or aspiration were recordedin either group.Conclusion:In patients with type 2 diabetes, consuming a Carboload drink two hours before surgery was safe and didnot increase the risk of pulmonary aspiration. Although there was a slight increase in their preoperative blood glucose levels, the postoperative glucose levels were easier to control and required a lesser amount of insulin to achieve normoglycemia.Moreover, we found a remarkable improvement in the patient’s well being as the carbohydrate consumed group experiencedless thirst, and hunger. Patients with Type 2 diabetes may benefit from the physiologic benefits of this beverage, justas do patients without diabetes in enhanced recovery after surgery (ERAS) protocols. RBS levels during the perioperative period (mg/dl)
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