Preoperative maltodextrin in minimally invasive colorectal surgery: Is it safe for diabetics? A randomised controlled trial.

Abstract

Preoperative fasting can result in thirst and fatigue. We evaluated the blood glucose levels during and after surgery following the administration of maltodextrin among patients including diabetics, undergoing minimally invasive colorectal surgery. One hundred and fifty patients undergoing colorectal surgery were randomised into group CL (received 50 g of 12.5% maltodextrin dissolved in 400 ml of water 2 h before surgery) and group W (received 400 ml of plain water 2 h before surgery). Blood glucose was checked at T0 (induction of anaesthesia), T2 (2 h), T4 (4 h), T6 (6 h) of surgery and eight hourly postoperatively in the intensive care unit (ICU) for 24 h. Thirst or discomfort before induction, gastric aspirate after intubation, incidence of hyperglycaemia and need for insulin intervention intra- and postoperatively were also assessed. Mean (standard deviation [SD]) blood glucose levels were lower at T2 in group CL (136.2 [28.4] mg/dl) than in group W (157.8 [37.8] mg/dl) (P < 0.001). It remained lower in group CL at T4 (P = 0.008), T6 (P = 0.009), T8 ICU (P = 0.012), T16 ICU (P = 0.001) and T24 ICU (P = 0.001). The thirst scores were superior in group CL (P < 0.001). Among diabetic patients, blood glucose levels remained significantly lower at T2 (P < 0.001), T4 (P = 0.002), T6 (P = 0.002), T8 ICU, T16 ICU and T24 ICU (P = 0.016, 0.025 and 0.003, respectively). Lesser number of insulin interventions at T4 (P = 0.006), T6 (P = 0.002), T8 ICU (P = 0.025) and T16 ICU (P = 0.012) was needed in group CL in the diabetic subgroup. Preoperative administration of oral maltodextrin lowers the blood glucose levels from 2 h into surgery until 24 h postoperatively, even among controlled diabetic patients, and improves preoperative thirst scores in patients undergoing minimally invasive colorectal surgery.