Carbohydrate Drink Research Articles

The revelance of the development of new reciples of protein-vitaminized products for sports nutrition in Kazakhstan (in Kazakh language)

The specificity of sports nutrition lies in the fact that a person uses various carbohydrate, protein and vegetable drinks to restore the body after physical activity. Currently, in the sports nutrition market of the CIS countries, including our country, products from other countries account for more than 95%. Because of this, the prices of sports products are very expensive. Therefore, the development of sports nutrition products containing highly digestible protein products for the body based on plant raw materials is very relevant. At the same time, the development of these products based on legumes, in particular, their peas and soybeans, is the most acceptable. In addition, pea protein can be used to build muscle mass - due to the high level of L-arginine contained in it, the protein stimulates the secretion of human growth hormone, which is involved in the regulation of growth, metabolism and muscle mass. This article presents materials on the relevance of the development of new formulations of protein - fortified products for sports nutrition in Kazakhstan.

Determinants of late recovery following elective colorectal surgery.

Despite the implementation of enhanced recovery protocols, a significant proportion of patients experience delayed recovery. Identifying potential determinants of delayed recovery is crucial for optimizing perioperative protocols and tailoring patient pathways. This study aims to identify possible determinants of delayed recovery. Retrospective observational study based on a prospectively collected dedicated register spanning from 2015 to 2022. Twenty-two Italian hospitals specializing in high-volume colorectal surgery and trained in enhanced recovery protocols. Patients undergoing elective colorectal resection for cancer or benign disease. Recovery status on postoperative day 2. Late recovery was defined as the failure to meet at least two indicators of postoperative recovery (oral feeding, removal of the urinary catheter, cessation of intravenous fluids, and mobilization) on postoperative day 2. A total of 1535 patients were analyzed. The median overall adherence to pre- and intraoperative enhanced recovery protocol items was 75.0% (range: 66.6%-83.3%). Delayed recovery was observed in 487 (31.7%) patients. Multiple regression analysis revealed six enhanced recovery protocol items that independently positively influenced postoperative recovery: pre-admission counseling (adjusted odds ratio [aOR] 2.596), a preoperative carbohydrate drink (aOR 1.948), intraoperative fluid infusions < 7ml/kg/h (aOR 1.662), avoidance of thoracic epidural analgesia (aOR 2.137), removal of nasogastric tube at the end of surgery (aOR 4.939), and successful laparoscopy (aOR 2.341). The rate of delayed recovery progressively decreased with increasing adherence to these six positive items, reaching 13.0% when all items were applied (correlation coefficient [r] = - 0.99, p < 0.001). This study is limited by its retrospective analysis of a register containing data from multiple centers and a diverse patient population. Adherence to specific pre- and intraoperative enhanced recovery protocol items, including counseling, preoperative carbohydrate intake, restrictive intraoperative fluid management, avoidance of thoracic epidural analgesia, early removal of nasogastric tube, and successful laparoscopy, appears crucial for promoting early recovery following elective colorectal resection.

Nursing intervention in acute or critically ill patients with thirst: an integrated review

Aim: Analyze the existing nursing interventions and their effectiveness in managing thirst and promoting the person’s comfort. Background: Thirst is a symptom often experienced by people hospitalized in an acute and/or critical situation, but it is still frequently under-evaluated and under-treated in clinical practice, one of the main reasons being the difficulty in assessing thirst when it comes to people with an altered state of consciousness. Methods: To analyze the existing nursing interventions in managing thirst and promoting the person’s comfort, an integrative review was elaborated through electronic databases MEDLINE, CINAHL, PubMed, and other sources from March 2023 to August 2023. The review protocol is registered (PROSPERO CRD42023413584) and this review integrates a Project in a Higher School of Nursing. Results: After assessing eligibility, 16 final documents were obtained for data extraction and analysis. The results obtained show that several effective strategies were identified to thirst relief, such as drinking cold liquids, ingestion of carbohydrate drinks when fasting is really necessary, the use of ice, performing oral hygiene, applying lip moisturizer, using mentholated substances, controlling the ambient temperature, use of salivary stimulants and artificial saliva. Conclusions: This is a sensitive area of nursing care. Thus, a more significant investment in the scope of nursing research and the development of innovative technology that can improve nursing interventions for the management and thirst relief, would be beneficial to improve the quality of the nursing care provided for hospitalized patients in critical care.

A retrospective study of pre-operative fasting times prior to elective or emergency cesarean birth in a large maternity hospital: Lessons to be learned to minimize the fasting time.

When managing elective and emergency cesarean births in the same operating room, unpredictable variations in the start times of the cesareans can prolong fasting periods. The fasting times were retrospectively analyzed on 279 consecutive cesarean births at Helsinki University Women's Hospital, Finland, during January-February 2023. The fasting times were compared between the urgency groups and for elective cesareans according to their scheduled order on the operation list. The primary outcome was the difference in the fasting times for food and drink, while the secondary outcome was fasting for both food >12 h and fluids >4 h. The fasting times were compared by one-way ANOVA and chi-squared test, respectively. Dichotomous data are presented as unadjusted odds ratios (OR with 95% CI). Increasing urgency was associated with shorter fasting times. Fasting times for elective cesareans increased with the scheduled order on the daily list. The mean fasting periods (SD) increased from 10.55 h (SD=1.57) to 14.75 h (SD=2.02) from the first to the third cesarean of the day (p<0.01). The unadjusted odds ratio (95% CI) for fasting of the scheduled cesareans to exceed 12 h for solid foods and 4 h for clear fluids was 6.53 (95% CI: 2.67-15.9, p<0.001), for the third and fourth cesareans compared to the first two cesareans of the day. When elective and emergency cesareans are performed by the same team, the woman undergoing the third elective surgery of the day should be advised to have breakfast before 5 a.m. at home. While waiting for the operation, a carbohydrate drink should be offered to limit the fast.

Enhanced Recovery After Surgery: An Example of Integrated Care for Coronary Artery Bypass Graft Surgery

After post-coronary artery bypass surgery, patients often experience physiological issues such as pain and complications as well as psychological issues such as fatigue and depression. These issues may burden family caregivers and impact patient quality of life. Therefore, a comprehensive, multidisciplinary integrated care plan is needed to expedite postoperative recovery and reduce the social burden on patients. In recent years, government promotion of integrated healthcare, including the implementation of postoperative accelerated recovery care models, has led to the introduction of the enhanced recovery after surgery program as part of post-cardiac surgery integrated care. This program, providing combined care that is multidisciplinary and evidence-based, incorporates elements such as the provision of carbohydrate drinks, multimodal pain management, and fluid management. Reducing to a minimum the emotional and physiological stresses on patients facilitates a faster return to normal functionality. In this paper, a literature review is conducted to provide a reference for future post-coronary artery bypass surgery care by clinical teams, with the aim of offering an integrated approach to patient care.

Pre-operative carbohydrate drink in pediatric spine fusion: randomized control trial.

As rapid discharge protocols for pediatric spine fusion shorten stays, gastrointestinal (GI) complications are uncovered and cause delays in discharge. A pre-operative carbohydrate (CHO) drink has been shown to improve perioperative GI symptoms and functional return but has not been examined in pediatric spine patients. We aimed to determine if a preoperative CHO drink is safe in pediatric spine fusion patients, and if it improves their comfort scores and return of bowel function. We prospectively randomized ASA-1 and -2 pediatric spine fusion patients to either a pre-anesthesia carbohydrate drink 2h prior to surgery or to a control group (standard 8h NPO), blinded to surgical team. We documented time to return to flatus, bowel movement, GI symptoms, and comfort scores for 72h post-operatively or until discharge. 62 patients were randomized. There was no significant differences between the groups' pre-operative characteristics, surgical details, nor post-operative morphine dose equivalents, except for EBL (405cc control, 340cc CHO drink, p = 0.044). There were no perioperative complications related to ingestion of the CHO drink. CHO group had a positive trend for earlier return of flatus (21% vs. 3% return at 12h), and comfort scores for anxiety and abdominal pain, but no statistically significant differences. There was no difference in length of stay or time to first bowel movement. There were no complications related to ingestion of a CHO drink 2h prior to pediatric spinal fusion surgery. Further studies are needed to develop a study blinded to the participants with larger sample size. Level of evidenceI.

A feasibility study on preoperative carbohydrate loading in older patients undergoing hip fracture surgery

BackgroundPreoperative carbohydrate loading in Enhanced Recovery After Surgery is an independent predictor of postoperative outcomes. By reducing the impact of surgical stress response, fasting-induced insulin resistance is modulated. As a clear fluid, consuming carbohydrate drink is safe up to 2 h preoperatively. Widely practiced in abdominal surgeries, its implementation in hip fracture surgeries is yet to be recognized. This study aimed to identify the feasibility of preoperative carbohydrate loading in hip fracture surgery and assess its clinical effects.MethodsThis was a randomized controlled, open labelled trial. Patients ≥ 65 years old without diabetes mellitus, has hip fracture were recruited in a tertiary hospital between November 2020 and May 2021. The intervention was carbohydrate loading versus standard preoperative fasting.ResultsThirty-four ASA I-III patients (carbohydrate loading and control, n = 17 each), mean age 78 years (SEM ± 1.5), mean body mass index 23.7 (SEM ± 0.6 kg/m2) were recruited. Analysis for feasibility of carbohydrate loading (n = 17) demonstrated attrition rate of 29% (n = 5). Otherwise, all recruited patients were compliant (100% compliance) with no adverse events reported. There was no significant difference among groups in the postoperative nausea and vomiting, pain score, fatigue level, muscle strength, postoperative infection and length of hospital stay assessed at 24–48 h postoperatively.ConclusionThe implementation of preoperative carbohydrate loading was found to be feasible preoperatively in hip fracture surgeries but requires careful coordination among multidisciplinary teams. An adequately powered randomized controlled study is needed to examine the full benefits of preoperative carbohydrate loading in this group of patients.Trial registrationThis study was registered in ClinicalTrial.gov (ClinicalTrials.gov identifier: NCT04614181, date of registration: 03/11/2020).

Effect of Combined Intra-Session Glucose and Fructose Intake on the Performance of Young Super-Sprint Triathletes: A Randomised, Crossover, Blind, Placebo-Controlled Study

Carbohydrate intake is a commonly used strategy in sports, and supplementation for triathletes includes pre-competition, intra-competition, and post-competition intake. The consumption of fructose–glucose improves intestinal transit and gastric emptying. The main purpose of this study was to analyse the effect of intra-session carbohydrate intake in triathletes training in the super-sprint modality. Eleven adolescent triathletes (boys, n = 9, 14.6 years; girls, n = 2, 15.2 years) participated in a crossover, randomised, and blind study on the effect of supplementation with 45 g of carbohydrates (glucose:fructose; 1:2) The participants performed two super-sprint tests (swimming 250 m, cycling 6 km, and running 2 km) with a rest period (2 h) during which they drank a placebo drink (PG) or a carbohydrate drink (SG). The effect on blood glucose was evaluated, but there were no significant changes in glucose values. However, it was higher in the SG after supplementation. No significant differences were found in the cycling, swimming, and running tests, except for RPE in the swimming sector (p &lt; 0.05). Neither were significant changes in body weight observed during the assessments. Supplementation with 45 g of liquid carbohydrates composed of fructose and glucose in a 2:1 ratio was not effective for delaying fatigue or improving performance markers or blood glucose levels in super-sprint triathletes.

Association of adherence to the enhanced recovery after surgery pathway and outcomes after laparoscopic total gastrectomy

ObjectiveThe current study used a composite outcome to investigate whether applying the ERAS protocol would enhance the recovery of patients undergoing laparoscopic total gastrectomy (LTG).ExposuresLaparoscopic total gastrectomy and perioperative interventions were the exposure. An ERAS clinical pathway consisting of 14 items was implemented and assessed. Patients were divided into either ERAS-compliant or non-ERAS-compliant group according the adherence above 9/14 or not.Main outcomes and measuresThe primary study outcome was a composite outcome called ‘optimal postoperative recovery’ with the definition as below: discharge within 6 days with no sever complications and no unplanned re-operation or readmission within 30 days postoperatively. Univariate logistic regression analysis and multivariate logistic regression analysis were used to model optimal postoperative recovery and compliance, adjusting for patient-related and disease-related characteristics.ResultsA total of 252 patients were included in this retrospective study, 129 in the ERAS compliant group and 123 in the non-ERAS-compliant group. Of these, 79.07% of the patients in ERAS compliant group achieved optimal postoperative recovery, whereas 61.79% of patients in non-ERAS-compliant group did (P = 0.0026). The incidence of sever complications was lower in the ERAS-compliant group (1.55% vs. 6.5%, P = 0.0441). No patients in ERAS compliant group had unplanned re-operation, whereas 5.69% (7/123) of patients in non-ERAS-compliant group had (p = 0.006). The median length of the postoperative hospital stay was shorter in the in the ERAS compliant group (5.51 vs. 5.68 days, P = 0.01). Both logistic (OR 2.01, 95% CI 1.21–3.34) and stepwise regression (OR 2.07, 95% CI 1.25–3.41) analysis showed that high overall compliance with the ERAS protocol facilitated optimal recovery in such patients. In bivariate analysis of compliance for patients who had an optimal postoperative recovery, carbohydrate drinks (p = 0.0196), early oral feeding (P = 0.0043), early mobilization (P = 0.0340), and restrictive intravenous fluid administration (P < 0.0001) were significantly associated with optimal postoperative recovery.Conclusions and relevancePatients with higher ERAS compliance (almost 70% of the accomplishment) suffered less severe postoperative complications and were more likely to achieve optimal postoperative recovery.

Effects of preoperative and postoperative carbohydrate loading on gastrointestinal function and stress-induced inflammation after radical prostatectomy

Background: Early postoperative oral clear liquid diet has been shown to enhance postoperative recovery. However, the standard strategy for this diet has not been established. The authors’ aim was to investigate the combined effect of preoperative and early postoperative carbohydrate loading on postoperative stress and gastrointestinal function of patients by standardizing the starting time, type, volume, and concentration of carbohydrate drinks. Materials and methods: Fifty-three patients undergoing radical prostatectomy were randomly assigned to two groups. Both groups received a carbohydrate loading of 400 ml (12.5%) overnight and 2 h before surgery. The intervention group (n=29) started a 400 ml (12.5%) carbohydrate loading 6 h after surgery and consumed it within 24 h, while the control group (n=32) drank water. The primary outcomes–postoperative fasting blood glucose, fasting insulin, C-reactive protein (CRP), interleukin-6 levels, and gastrointestinal function–were recorded. Secondary outcomes included subjective comfort assessment, the first postoperative intake of semi-fluid food time, and drainage volume. Results: Compared with the control group, the intervention group had lower CRP levels on postoperative day 1 (POD1)/POD2 and less drainage volume on POD1. The intervention group also experienced shorter times to the first postoperative flatus and the first consumption of semi-fluid foods; their 72-h postoperative protein intake was higher than that of the control group. Conclusion: The results suggest that combined preoperative and postoperative carbohydrate loading can alleviate stress-induced inflammation and promote the recovery of postoperative gastrointestinal function.

The safety of preoperative carbohydrate drinks in extremely elderly patients assessed by gastric ultrasonography: a randomized controlled trial

BackgroundModern perioperative guidelines encourage drinking oral carbohydrates 2 h before management. Nevertheless, research on the safety of preoperative carbohydrate drinks, particularly in extremely elderly patients is lacking. We aimed to evaluate the safety of carbohydrate drinks 2 h before surgery in extremely elderly patients (≥ 80 years) using gastric ultrasonography.MethodsWe conducted a randomized prospective comparative study of 70 patients aged over 80 years who were scheduled for total knee arthroplasty, hip fracture or humerus fracture surgery. These patients were randomly assigned to the carbohydrate group (n = 35), which fasted from midnight, except for drinking 355 mL of a carbohydrate-containing fluid 2 h before surgery, or the fasting group (n = 35), which fasted from midnight and drank no fluid before surgery. The primary outcome of the study was the cross-sectional area (CSA) of the gastric antrum in the right lateral decubitus position (RLDP) before surgery. The secondary outcomes included CSA in the supine position, intraoperative blood glucose levels and their variability coefficients, Perlas grade, and the visual analog scale of subjective feelings.ResultsThe CSA in the RLDP and supine positions revealed no differences between the carbohydrate and fasting groups at 0 h preoperatively (P > 0.05). In the qualitative assessment, preoperative 0-h Perlas grading did not differ significantly between the groups (P > 0.05). From 2 h before surgery to transfer out of the post-anesthesia care unit, the average blood glucose level of patients in the carbohydrate group was significantly higher than that in the fasting group (P < 0.001) but remained within the normal range. Moreover, the blood glucose variability coefficient was significantly lower in the carbohydrate group than in the fasting group (P = 0.009). Oral intake of 355 mL carbohydrates before surgery significantly relieved patients’ feelings (P < 0.001).ConclusionPreoperative consumption of carbohydrate drinks 2 h before surgery is safe in “healthy” extremely elderly patients. In addition, preoperative drinking has potential value in maintaining ideal blood glucose levels and stable blood glucose fluctuations perioperatively and improving subjective perceptions of preoperative preparation. This finding warrants further investigation in clinical practice.Trial registrationChinese Clinical Trial Registry (Registration Number ChiCTR1900024812), first registered on 29/07/2019.

No effect of a commercial carbohydrate‐menthol drink on thermal perceptual measures or 15‐min time trial performance compared to commercial carbohydrate drink in hot humid conditions

AbstractThis study assessed the effect of a commercial carbohydrate menthol drink on cycling time trial (TT) performance in hot and humid conditions compared with a carbohydrate only drink. Ten participants (5 women; V̇O2max: 52.3 ± 8.6 mL kg−1 min−1, Peak Power Output: 286 ± 56 W) completed a 40‐min cycling preload (50% V̇O2max) followed by a 15‐min self‐paced TT in hot (∼35°C) and humid (∼54%) conditions on two occasions (double blind, crossover design). Every 10‐min, 85 mL of carbohydrate (CHO; SIS GO Energy, 60 g h−1) or carbohydrate and menthol (CHO + MEN; SIS Turbo+ 60 g h−1, 0.01% menthol) was swilled (∼10‐s) and ingested. Rectal temperature (Trec) and heart rate (HR) were recorded throughout. Thermal sensation (TS), thermal comfort (TC) and rating of perceived exertion (RPE) were recorded every 5‐min. Taste and aftertaste were rated from very pleasant (+5) to very unpleasant (−5). TT performance (total work; kJ) was similar between CHO (153 kJ [95% CI: 129–177 kJ]) and CHO + MEN (151 kJ [128–178 kJ]). During preload exercise, Trec increased by ∼0.9°C and was similar at the end of the TT (∼38.20°C). Mean preload HR was ∼140 b min−1 in each condition and reached ∼177 b min−1 at the end of the TT. TC was rated as ‘much too warm’ and TS rated as ‘very hot’ in both conditions. Both conditions were ‘extremely hard’ (end point RPE ∼19). All participants preferred the taste and aftertaste of the CHO drink. The commercial carbohydrate menthol drink offered no additional ergogenic benefit compared to a carbohydrate only drink during cycling exercise performed in hot and humid conditions.

Does a Preoperative Carbohydrate Drink Reduce Postoperative Inflammation? A Systematic Review and Meta-Analysis

Since 1995, it has been known that carbohydrate drinks (CHDs) can be safely consumed two to three hours (2–3 h) preoperatively. Furthermore, preoperative CHDs significantly benefit many outcomes, such as thirst, hunger, and insulin resistance. Patients, however, still fast excessively. This study aimed to determine if a CHD, consumed 2–3 h preoperatively, impacts postoperative inflammation compared to a placebo drink or fasting. This was achieved through analysing the levels of interleukin-6, C-reactive peptide, and serum albumin 10–24 h postoperatively. We conducted a systematic review of randomised control trials. We comprehensively searched the Embase, MEDLINE and Web of Science databases, identified 473 studies, and, after screening, were left with 10 randomised control trials. Our meta-analyses found a significantly lower mean interleukin-6 level of −21.26 pg/mL ((95% CI −33.37, −9.15); p = 0.0006) postoperatively in patients given a preoperative CHD compared to fasting and a significantly higher mean serum albumin level of 2.56 g/L ((95% CI 1.41, 3.71); p &lt; 0.0001) postoperatively in patients given a preoperative CHD compared to a placebo. Our results therefore show that a CHD, consumed 2–3 h preoperatively, lowers proinflammatory cytokine levels and increases serum albumin levels. Thus, our study reinforces guideline recommendations to give patients a CHD 2–3 h preoperatively for improved outcomes.

Quality surgery for gastrointestinal cancers in the Deep South: Disparities in elements of the Enhanced Recovery Program.

183 Background: Disparities in surgical outcomes exist for Black gastrointestinal cancer patients and may be due to the lower likelihood of undergoing quality surgery that minimizes adverse surgical outcomes. The Enhanced Recovery Program (ERP) has shown to improve perioperative outcomes through standardization of care and to reduce disparities in surgical outcomes in certain settings. The extent to which ERP is applied across patient groups is currently unclear, especially for patients in high poverty states of the Deep South. Methods: The ASCENDS study conducted a survey of colorectal, pancreatic, and esophageal cancer patients (stage 1-3, diagnosed within 5 years, had surgery) in Alabama and Mississippi. Survivors were recruited through the Alabama Statewide Cancer Registry and select hospitals in these states. Survey questions asked about selected ERP components including: 1) education and counseling about surgery, i.e., i) surgeon/other health care provider in surgery clinic gave instructions about getting ready for surgery, ii) instructions were definitely easy to understand; 2) carbohydrate drink before surgery (e.g., Sprite); 3) pain medication; 4) anti-thrombotic and antibiotic prophylaxis; 5) bladder catheter (removed day after surgery); 6) early mobilization (walking) and nutrition on day of surgery, and mobilization the day after surgery. Fisher Exact or Chi Square tests were performed to examine significant differences across White (W) and Black, Indigenous, or persons of color (BIPOC) respondents. Results: Of 272 survey respondents (mean age 63.17±11.57, range 23-92), 71.3% were W, 28.3% BIPOC, 55.5% women, 76.8% had colorectal,16.2% pancreatic, and 7% esophageal cancer, 58.8% were from rural areas, 33.8% had low health literacy, 46.7% had private insurance, 32.3% Medicaid or Medicare/Medicaid, and 21.7% Medicare. See Table 1. Conclusions: Overall, there were no disparities in ERP components as recalled by survey respondents. Low uptake of some of the ERP components is worrisome, although data from medical records is needed to confirm findings. Improvements may be needed to improve surgery outcomes for alI GI cancer patients in the Deep South.[Table: see text]

Carbohydrate or Electrolyte Rehydration Recovers Plasma Volume but Not Post-immersion Performance Compared to Water After Immersion Diuresis.

We tested the hypothesis that a carbohydrate (CHO: 6.5%) or carbohydrate-electrolyte (CHO + E: 6.5% + 50 mmol/L NaCl) drink would better recover plasma volume (PV) and exercise performance compared to water (H2O) after immersion diuresis. Twelve men (24 ± 2 years; 82.4 ± 15.5 kg; and V̇O2max: 49.8 ± 5.1 mL · kg-1 · min-1) completed four experimental visits: a no-immersion control (CON) and three 4-h cold-water (18.0 °C) immersion trials (H2O, CHO, and CHO + E) followed by exercise in a warm environment (30 °C, 50% relative humidity). The exercise was a 60-minute loaded march (20.4 kg; 55% VO2max) followed by a 10-minute intermittent running protocol. After immersion, subjects were rehydrated with 100% of body mass loss from immersion diuresis during the ruck march. PV is reported as a percent change after immersion, after the ruck march, and after the intermittent running protocol. The intermittent running protocol distance provided an index of exercise performance. Data are reported as mean ± SD. After immersion, body mass loss was 2.3 ± 0.7%, 2.3 ± 0.5%, and 2.3 ± 0.6% for H2O, CHO, and CHO + E. PV loss after immersion was 19.8 ± 8.5% in H2O, 18.2 ± 7.0% in CHO, and 13.9 ± 9.3% in CHO + E, which was reduced after the ruck march to 14.7 ± 4.7% (P = .13) in H2O, 8.8 ± 8.3% (P < .01) in CHO, and 4.4 ± 10.9% (P = .02) in CHO + E. The intermittent running protocol distance was 1.4 ± 0.1 km in CON, 1.4 ± 0.2 km in H2O, 1.4 ± 0.1 km in CHO, and 1.4 ± 0.2 km in CHO + E (P = .28). Although CHO and CHO + E better restored PV after immersion, post-immersion exercise performance was not augmented compared to H2O, highlighting that fluid replacement following immersion diuresis should focus on restoring volume lost rather than fluid constituents.

Preoperative carbohydrate drink in fast-track primary total knee arthroplasty: a randomized controlled trial of 168 patients.

A key component in fast-track total knee arthroplasty (TKA) is early mobilization. Preoperative fasting might cause orthostatic hypotension and -intolerance which both can interfere with early mobilization. It was hypothesized that consuming a carbohydrate drink 2-3 hours prior to surgery is a viable option to reduce orthostatic hypotension, and as a result, improve rehabilitation. In this randomized controlled trial, all consecutive unilateral primary TKA patients were reviewed for eligibility. Exclusion criteria were American Society of Anesthesiologists (ASA) class above 3, older than 80 years of age, Diabetes Mellitus, and an insufficient comment of Dutch language. Patients were distributed in two groups. The control group was allowed to eat till 6 hours and drink clear fluids till 2 hours before surgery (standard treatment). The intervention group consumed, additionally to the standard treatment, a carbohydrate drink 2-3 hours before surgery. Blood pressure was measured both lying and standing as a measure for orthostatic hypotension during first time postoperative mobilization on day of surgery. A total of 168 patients were included. Prevalence of orthostatic hypotension in the control- and intervention group was 24 patients (34%) and 14 patients (19%) respectively, (p=0.05). Prevalence of orthostatic intolerance was 13 patients (19%) in the control group and 9 patients (13%) in the intervention group (p=0.32). No drink related adverse events occurred. In conclusion, taking a carbohydrate drink 2-3 hours before TKA significantly lowers the number of patients with orthostatic hypotension in early mobilization. However, the clinical relevance of the carbohydrate drink has to be studied further.

Current Status of and Barriers to the Implementation of Enhanced Recovery After Surgery in 77 Tertiary Hospitals

To investigate the status of and obstacles to the implementation of enhanced recovery after surgery (ERAS) in tertiary-care general hospitals in China. Questionnaire on the Current Status of and Barriers to the Implementation of ERAS in Tertiary-Care Hospitals, a self-developed questionnaire, was used to conduct a survey of 77 tertiary hospitals from 21 provinces across China between May 2022 and June 2022. The participating hospitals were selected by convenience sampling. The questionnaire on the current implementation status of ERAS was mainly focused on the departments involved and the ERAS programs implemented, incorporating a total of 25 items of three dimensions, preoperative, intraoperative, and postoperative. The answer to each question consisted of 5 options from "never" to "always", which corresponded to 1 to 5 points on the scoring scale, with the higher scores indicating better implementation of the program concerned. In the questionnaire on barriers to ERAS implementation and recommendations, 10 items of two dimensions, including hospital management, and patient and caregiver, were concerned with the barriers to implementation. The answer to each question consisted of 5 options from "disagree" to "strongly agree", which corresponded to 1 to 5 points on the scoring scale, with the higher scores indicating the greater importance of the barriers. ERAS programs were implemented in 73 (94.8%) hospitals. The best-implemented items were preoperative education (4.73±0.51), prevention and treatment of deep vein thrombosis (4.55±0.71), and postoperative follow-up (4.40±0.81). The items of poor implementation status were preoperative prehabilitation (2.71±1.40), preoperative oral carbohydrate drinks (3.03±1.49), and early ambulation after surgeries (3.04±1.22). The main obstacles to ERAS implementation included a lack of effective incentive systems, poor motivation among the medical and nursing staffs (3.21±0.93), a lack of disease-specific clinical implementation pathways (3.16±1.06), and a lack of experience in multidisciplinary teamwork (2.98±1.17). There is a high rate of ERAS implementation in tertiary general hospitals in China, but clinical implementation and dissemination are still confronted with many obstacles.

Oral Carbohydrate Administration was Suitable for Cesarean Section–A Systematic Review and Meta-Analysis of Randomized Trials

The use of carbohydrate (CHO) drinks prior to elective cesarean section has gained momentum, but its effect on maternal and neonatal outcomes remains controversial. The aim of this meta-analysis was to assess the effect of an oral CHO load prior to cesarean delivery on insulin sensitivity, insulin resistance, maternal glycemia, neonatal glycemia, and breastfeeding. As of May 21, 2023, we searched through five databases for English-language experimental studies on pre-cesarean oral CHO. A total of 3,940 citations were received, of which seven were selected. The concentrations of CHO used in these studies ranged from 5.9% to 14.2%, and the amounts used were 300-400 ml. We found that pre-cesarean CHO loading reduced maternal insulin resistance and increased maternal glucose levels. CHO loading activates the insulin pathway of critical en-zymes to some extent, increasing glucose utilization by peripheral tissues and ultimately reducing postop-erative insulin resistance. Of course, this is also beneficial in improving maternal blood sugar. We did not find that CHO increased maternal insulin sensitivity or neonatal blood glucose levels. Future prospective randomized controlled trials can use nutritional load to increase colostrum production after Caesarean sec-tion to enhance the confidence of these mothers in breastfeeding. In addition, our preoperative beverage could be more individualized to accommodate diabetic women.

Effects of Grape Syrup Intake on Metabolic Rate and Substrate Oxidation During and After Sprint Intermittent Exercise

Background: Regarding sports drinks' role in substrate oxidation, the present study investigated the effect of grape syrup intake on metabolic rate and substrate oxidation after sprint intermittent exercise in active male students. Methods: In a double-blind, placebo-controlled, crossover study, 12 active male college students (body mass = 62.77 ± 9.05 kg; height = 173 ± 6.78 cm; BMI = 21 ± 2.5 kg/m2) were divided into two groups and performed two separate exercise sessions after grape syrup (1.1 mL/kg. body weight) or placebo intake. In the exercise session, subjects performed four 30-second Wingate tests (75 g / kg body weight) with a 5‐minute rest period. Energy expenditure (EE), respiratory exchange ratio (RER), fat oxidation (FO), heart rate (HR), and oxygen intake (VO2) were assessed 5 minutes before, during, and 30 minutes after exercise. Statistical analysis was performed using mixed-model ANOVA with repeated measures. Results: The results showed only between-group differences in respiratory exchange ratio (P = 0.04). However, the effect of time was significant between different situations (before, during, and after SIE) on all variables (P &lt; 0.05). No time-group interaction effect was also observed in investigated variables (P &gt; 0.05). The effect of different measurement times showed that in the post-SIE period, RER and fat oxidation rate values respectively decreased and increased compared to pre-SIE (P &lt; 0.05) in both situations. Conclusions: The grape syrup intake improved metabolic rate and substrate oxidation during the recovery period after SIE, comparable to the placebo-containing synthetic carbohydrates. Therefore, it is recommended to use this herbal supplement as a substitute for a carbohydrate drink during SIE. However, more research is needed in this case.

FTP4.8 A survey on enhanced recovery after surgery (ERAS) in Pakistan

Abstract Introduction ERAS protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the stress response following surgery. Despite a significant body of evidence indicating that ERAS protocols lead to improved outcomes, implementation has been slow, and is not yet universal. The aim of this study was to evaluate current implementation of enhanced recovery protocols among Pakistani surgeons. Methods A survey questionnaire consisting of 23 items was created to assess current trends in perioperative management of patients undergoing major surgery, and to ascertain the extent to which ERAS is understood and implemented. Results The survey was answered by 100 individuals. 32 % of participants were familiar with ERAS protocols. All participants gave pre-operative counselling. 26% performed preoperative nutritional assessment with provision of pre-operative nutritional support in 24 % cases. Anaemia was managed in 84 % cases and smoking cessation done in 70 %. Patients were kept nil per oral for &amp;gt; 6 hrs in about 80 % cases. Antibiotic prophylaxis given in 94 % cases. Preoperative loading with carbohydrate drinks is carried out in only 2% of cases with 90 % being unfamiliar with the term; nasogastric tube done (58 %), transurethral drainage (42%). opioid analgesia use 54 % and multi modal analgesia used in only 32 %. Prophylaxis for postoperative nausea and vomiting (34%), VTE prophylaxis 26 %. Early mobilization (84%) and early feeding in only 32 % was performed. Conclusion An ERAS program requires a dedicated multidisciplinary team willing to abandon out-dated paradigms and embrace new ideas.