Effect Of Preoperative Carbohydrate Loading Research Articles

Impact of preoperative carbohydrate loading on postoperative course and morbidity in debulking surgery for epithelial ovarian cancer.

Despite the theoretical benefits, the favorable effect of preoperative carbohydrate loading on postoperative morbidity remains controversial. Most of the outcomes reported in the literature are derived from non-gynecologic surgery data, with only one study involving a limited number of patients specifically in gynecological oncology. The present study aimed to investigate the impact of carbohydrate loading, as a single element of enhanced recovery after surgery protocols, on postoperative course and morbidity in patients undergoing debulking surgery for epithelial ovarian cancer (EOC). The present study was a non-randomized, prospective cohort trial enrolling patients with EOC who underwent surgery between June 2018 and December 2021. An oral carbohydrate supplement with a dose of 50 g was given to patients 2-3 h before anesthesia. Data on postoperative course and morbidity were collected and compared with data of a historical cohort including consecutive patients who underwent surgery without a carbohydrate loading between January 2015 and June 2018. Analyses were performed on a total of 162 patients, including 72 patients in the carbohydrate loading group and 90 patients in the control group. Median length of hospital stay (11 days vs. 11 days; P=0.555), postoperative days 1-7 serum c-reactive protein levels (P=0.213), 30-day readmission (11.6% vs. 11.5%, P=0.985), 30-day relaparotomy (2.8% vs. 3.4%, P=0.809) and 30-day morbidity (48.6% vs. 46.7%; P=0.805) were comparable between the cohorts. No significant differences in grades of morbidities were identified between the cohorts (P=0.511). Multivariate analysis revealed that the sole independent risk factor for any postoperative morbidity was operative time. In conclusion, based on the results of the present study, postoperative course and morbidity seemed to be unaffected by carbohydrate loading in patients undergoing debulking surgery for EOC.

Effect of pre-operative carbohydrate loading on aspiration risk evaluated with ultrasonography in type 2 diabetes patients: a prospective observational pilot study

Owing to concerns about delayed gastric emptying or hyperglycemia, evidence is lacking regarding whether pre-operative carbohydrate loading can be routinely administered to patients with type 2 diabetes. The objective of this study was to determine the aspiration risk and gastric volume after pre-operative carbohydrate loading in patients with type 2 diabetes. A prospective, single-center, observational cohort study. The study was conducted at a tertiary teaching hospital in Seoul, Korea, from May 2020 to May 2021. Patients (n = 49) with type 2 diabetes underwent elective noncardiac surgery. All patients were administered carbohydrate loading two hours before surgery. Once in the operating room, they underwent gastric ultrasonography to determine gastric volume. The anesthesiologists monitored the patients' glucose concentrations during and after surgery. The primary outcome was the predicted risk of aspiration. The secondary outcomes were gastric volume, antral grade, satisfaction score, and perioperative glucose profile. Forty-nine patients were analyzed. All patients had a low risk of aspiration after carbohydrate loading, as follows: 33 (67.3%) patients classified as antral grade 0 and 16 (32.7%) patients classified as antral grade 1. The median time from carbohydrate drink ingestion to ultrasound examination was 120 min (IQR 115–139). After carbohydrate loading, the median gastric volume in the right-lateral position after carbohydrate loading was 2.64 ml (IQR 0.00–32.05). The mean glucose concentrations (SD) were 134 (24) mg/dl, 159 (37) mg/dl, 150 (32) mg/dl, and 165 (36) mg/dl at baseline, after induction, 30 min after surgery, and in the post anesthesia care unit, respectively. The median satisfaction score of the patients was 5 (IQR 4–5). Pre-operative carbohydrate loading may be feasible for patients with type 2 diabetes and without complications.Trial registration: ClinicalTrials.gov (NCT04456166). Registered on 2 July 2020.

The effect of pre-operative carbohydrate loading in femur fracture: a randomized controlled trial

BackgroundFemur fracture is a major burden among elderly people, leading patients to be bedridden for a long time in the hospital. The body is more likely to be in a catabolic state as a result of the prolonged fasting period required for surgery, leading to an increase in insulin resistance. Pre-operative carbohydrate loading has been shown to improve postoperative outcomes in several countries. The study aimed to evaluate the effect of pre-operative carbohydrate loading in femur fracture surgery.MethodsThis study was single-center, hospital-based, open-label, parallel-group randomized controlled trial conducted between August 2020 and November 2021. A total of 66 participants, aged 50 years and above having femur fractures planned for surgery were included in this study and assigned to the control (n = 33) and study (n = 33) groups through computer-generated random numbers. The control group was kept fasting from midnight to the next morning as in existence while the study group was intervened with carbohydrate loading according to the Enhanced Recovery After Surgery (ERAS) protocol. The pre-operative nutritional status was identified and the postoperative outcomes were measured using the Visual Analogue Score (VAS), Cumulative Ambulatory Score (CAS), and Modified Barthel Index (MBI) scoring systems. Statistical analyses were performed using the Chi-square test and the Student’s two-sample t-test to compare the outcomes between the two groups.ResultsAll the participants completed the study. There was a significant reduction in the average postoperative pain in the carbohydrate loading group (VAS: 4.8 (SD ± 1.8), 95% CI: 4.7–5.4) as compared to the control group (VAS: 6.1 (SD ± 2.1), 95% CI: 5.3–6.8). The average CAS showed a significant improvement in regaining the mobility function of participants in the study group (CAS: 8.1 (SD ± 2.8), 95% CI: 7.1–9.1) than that of the control group (CAS: 6.8 (SD ± 2.8), 95% CI: 5.8–7.8). The mean MBI score of the participants at the time of discharge from the hospital was higher in the study group (MBI:13.1 (SD ± 2.3), 95% CI: 12.2–13.9) compared to the control group (MBI: 11.8 (SD ± 3.1), 95% CI:10.6–12.9). Similarly, the length of hospital stay after surgery had decreased in the study group than in the control group.ConclusionsThe uptake of carbohydrate loading showed reduced post-operative pain, enhanced functional mobility, and decreased length of hospital stay. This study warrants larger trials to show the effect of pre-operative carbohydrate loading in a clinical setting.Trial registrationNCT04838366, first registered on 09/042021 (https://clinicaltrials.gov/ct2/show/NCT04838366).

Preoperative carbohydrate loading with individualized supplemental insulin in diabetic patients undergoing gastrointestinal surgery: A randomized trial

BackgroundPreoperative carbohydrate drink is used to improve patients’ comfort and recovery, but evidence remains limited in diabetic patients. Herein we investigated the effects of preoperative carbohydrate loading with individualized supplemental insulin regimen in diabetic patients undergoing gastrointestinal surgery. MethodsA total of 63 adult patients with type 2 diabetes mellitus undergoing major gastrointestinal surgery were randomized to receive either carbohydrate loading with individualized supplemental insulin (Carbohydrate group) or routine management (Control group). The primary outcome was time to first flatus after surgery. Among secondary outcomes, subjective feelings of thirsty, hunger and fatigue were assessed with the Visual Analogue Scale (scores range from 0 to 100, where 0 indicate no discomfort and 100 the most severe discomfort) before and after surgery. Adverse events were monitored until 24 h after surgery. ResultsAll patients were included in the intention-to-treat analysis. Time to first flatus did not differ between groups (median 41 h [IQR 18–69] in the Control group vs. 43 h [27–54] in the Carbohydrate group; hazard ratio 1.24 [95% CI 0.74–2.07]; P = 0.411). The VAS score of preoperative subject feeling of thirsty (median difference −33 [95% CI -50 to −15], P < 0.001), hunger (−25 [-40 to −10], P < 0.001), and fatigue (−5 [-30 to 0], P = 0.004), as well as postoperative subject feeling of thirsty (−50 [-60 to −30], P < 0.001), hunger (−20 [-40 to 0], P = 0.003), and fatigue (0 [-20 to 0], P = 0.020) were all significantly lower in the Carbohydrate group than in the Control group. Intraoperative hypotension (40.6% [13/32] vs. 16.1% [5/31], P = 0.031) and postoperative nausea and vomiting within 24 h (31.3% [10/32] vs. 9.7% [3/31], P = 0.034) occurred less in patients given carbohydrate drink. ConclusionIn diabetic patients undergoing gastrointestinal surgery, preoperative carbohydrate loading with individualized supplemental insulin did not promote gastrointestinal recovery but improved perioperative well-being.

Preoperative Carbohydrate Loading on Outcomes after Cardiac Surgery: A Flawed Meta-Analysis. Comment on: "The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials". Nutrients 2020, 12, 3105.

We read, with interest, the publication in Nutrients on the effects of preoperative carbohydrate loading on outcomes after cardiac surgery [...].

Reply to: “Preoperative Carbohydrate Loading on Outcomes after Cardiac Surgery: A Flawed Meta-Analysis. Comment on: The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients 2020, 12, 3904”

We appreciate the thoughts and questions posed by Drs Dileep N Lobo and Girish P Joshi [...].

The effects of preoperative oral carbohydrate drinks on energy intake and postoperative complications after hip fracture surgery: A pilot study

BackgroundHip fractures represent a major clinical burden for patients. Studies on the effect of preoperative carbohydrate loading before different surgical interventions have shown promising results but have not been tested in patients with hip fracture. AimThis study aimed to investigate the effects of preoperative oral carbohydrate drinks on the postoperative energy intake and incidence of complications after hip fracture surgery. MethodThis was a pilot study using a quasi-experimental design with a control group and an intervention group. ResultThe number of patients affected by more than one complication was higher in the control group than in the intervention group. According to the logistic regression analysis, the risk of any postoperative complication was reduced by approximately 50% OR (95% CI) 0.508 (0.23–1.10) in patients in the IG compared to those in the CG (p = 0.085). ConclusionThe result of this pilot study indicated that using preoperative carbohydrate drinks can decrease the number of postoperative complications in patients with a hip fracture. Furthermore, the number of patients who meet their energy needs during the first three days postoperatively might increase. More research is needed to confirm the effect of preoperative carbohydrate drinks.

The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials.

Background and aim: Preoperative fasting leads to metabolic stress and causes insulin resistance in patients undergoing cardiac surgery. The aim of this study was to assess the effect of preoperative oral carbohydrate loading (OCH) on outcome in patients undergoing planned cardiac surgery by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). Methods: Systematic search of PubMed/MEDLINE/Embase/Cinahl/Web of Science/ClinicalTrials databases was performed to identify relevant RCTs from databased inception until 05/03/2020. We included studies that compared outcome measures between OCH with control (placebo or standard starvation). We conducted a random-effect meta-analysis of clinical and biochemical parameters. Results: Nine studies (N = 9) were included with a total of 507 patients. OCH significantly decreased aortic clamping duration (n = 151, standardized mean difference (SMD) = −0.28, 95% confidence interval (CI) = −0.521 to −0.038, p = 0.023 and differences in means (DM) = −6.388, 95%CI = −11.246 to −1.529, p = 0.010). Patients from treatment groups had shorter intensive care unit (ICU) stay (n = 202, SMD = −0.542, 95%CI = −0.789 to −0.295, p < 0.001 and DM = −25.925, 95%CI = −44.568 to −7.283, p = 0.006) and required fewer units of insulin postoperatively (n = 85, SMD = −0.349, 95%CI = −0.653 to −0.044, p = 0.025 and DM = −4.523, 95%CI = −8.417 to −0.630, p = 0.023). The necessity to use inotropic drugs was significantly lower in the OCH group (risk ratio (RR) = 0.795, 95%CI = 0.689 to 0.919, p = 0.002). All other primary outcomes did not reveal a significant effect. Conclusions: Preoperative OCH in patients undergoing cardiac surgery demonstrated a 20% reduction in the use of inotropic drugs, a 50% reduction of the length of ICU stay, a 28% decrease in aortic clamping duration and a 35% decrease of postoperative insulin requirement.

Preoperative carbohydrate loading on perioperative temperature in patients undergoing general anesthesia

Objective The aim of this study is to investigate the effect of preoperative carbohydrate loading (CHO) on perioperative body temperature of gynaecological patients with general anesthesia. Methods Sixty female patients undergoing surgery were randomized to either fasting overnight (FAST group) or receive 800 ml of CHO in the evening before and 400 ml of CHO 2 h before anesthesia (CHO group)(n=30). Perioperative body temperatures (induction of anesthesia, after anesthesia 15, 30, 45, 60 min and the end of surgery) and degree of shivering were recorded. Results The basal temperature was not significantly different between two groups(P>0.05). The FAST group showed a significantly greater decrease in temperature from the baseline than the CHO group(P<0.05). Postoperative shivering scores of patients in FAST group is significantly higher than scores of patients in CHO group(P<0.05). Conclusions Preoperative carbohydrate loading reduces hypothermia in gynaecological patients under general anesthesia. Key words: Carbohydrate; Pretreatment; Perioperative; Hypothermia; Shivering

Effects of preoperative oral carbohydrates on quality of recovery in laparoscopic cholecystectomy: a randomized, double blind, placebo-controlled trial

While carbohydrate loading is an important component of enhanced patient recovery after surgery, no study has evaluated the effects of preoperative carbohydrate loading after laparoscopic cholecystectomy (LC) on patient satisfaction and overall recovery. Thus, we aimed to investigate the impact of preoperative oral carbohydrates on scores from the quality of recovery 40-item (QoR-40) questionnaire after LC. A total of 153 adults who underwent LC were randomized into three groups. Group MN-NPO was fasted from midnight until surgery. Group No-NPO received 400 mL of a carbohydrate beverage on the evening before surgery, and a morning dose of 400 mL was ingested at least 2 h before surgery. Group Placebo received the same quantity of flavored water as for group No-NPO. The quality of recovery after general anesthesia was evaluated using QoR-40 questionnaire. Intraoperative hemodynamics were also evaluated. There were no significant differences among the groups in terms of the pre- and postoperative global QoR-40 scores (P = 0.257). Group MN-NPO had an elevated heart rate compared to patients who ingested a preoperative beverage (groups No-NPO and Placebo; P = 0.0412). The preoperative carbohydrate beverage did not improve quality of recovery using the QoR-40 questionnaire after general anesthesia for laparoscopic cholecystectomy compared to placebo or conventional fasting. However, the preoperative fasting group had a consistently increased heart rate during changes in body position that induced hypotension, which is likely a result of depletion of effective intravascular volume caused by traditional fasting over 8 h. Clinical trial.gov identifier: NCT02555020.

Effects of Preoperative Oral Carbohydrates on Quality of Recovery in Laparoscopic Cholecystectomy: A Randomized, Double Blind, Placebo-Controlled Trial.

While carbohydrate loading is an important component of enhanced patient recovery after surgery, no study has evaluated the effects of preoperative carbohydrate loading after laparoscopic cholecystectomy (LC) on patient satisfaction and overall recovery. Thus, we aimed to investigate the impact of preoperative oral carbohydrates on scores from the quality of recovery 40-item (QoR-40) questionnaire after LC. A total of 153 adults who underwent LC were randomized into three groups. Group MN-NPO was fasted from midnight until surgery. Group No-NPO received 400mL of a carbohydrate beverage on the evening before surgery, and a morning dose of 400mL was ingested at least 2h before surgery. Group Placebo received the same quantity of flavored water as for group No-NPO. The quality of recovery after general anesthesia was evaluated using QoR-40 questionnaire. Intraoperative hemodynamics were also evaluated. There were no significant differences among the groups in terms of the pre- and postoperative global QoR-40 scores (P = 0.257). Group MN-NPO had an elevated heart rate compared to patients who ingested a preoperative beverage (groups No-NPO and Placebo; P = 0.0412). The preoperative carbohydrate beverage did not improve quality of recovery using the QoR-40 questionnaire after general anesthesia for laparoscopic cholecystectomy compared to placebo or conventional fasting. However, the preoperative fasting group had a consistently increased heart rate during changes in body position that induced hypotension, which is likely a result of depletion of effective intravascular volume caused by traditional fasting over 8h. Clinical trial.gov identifier: NCT02555020.

The effects of pre-operative carbohydrate loading on the metabolic response to surgery in a low resource setting

Introduction: the stress response to surgery involves catabolism and gluconeogenesis resulting in postoperative hyper glycaemia. Post-operative hyper glycaemia is a risk factor for postoperative complications and pre-operative fasting further aggravates this response. A carbohydrate (CHO) drink instead of fasting is expected to decrease insulin resistance and reduce post-operative hyper glycaemia. The aim of this study was to assess the effect of the reduction of the pre-operative fasting period on post-operative hyper glycaemia and post-operative complications in open surgery.

The effects of preoperative carbohydrate loading on the metabolic response to surgery in a low resource setting

BackgroundThe stress response to surgery involves catabolism and gluconeogenesis resulting in postoperative hyperglycaemia. Postoperative hyperglycaemia is a risk factor for postoperative complications and preoperative fasting further aggravates this response. A carbohydrate (CHO) drink instead of fasting is expected to decrease insulin resistance and reduce post-operative hyperglycaemia. The aim of this study was to assess the effect of the reduction of the pre-operative fasting period on post-operative hyperglycaemia and post-operative complications in open surgery. MethodsA hospital-based prospective case control study of 70 patients scheduled for elective surgery were sampled to either a case (carbohydrate-loaded) or a control (FAST) group. Postoperative hyperglycaemia and complications were the primary and secondary outcomes respectively reported. Results70 patients were recruited with 35 patients per group. 40 (57%) were females. The mean blood glucose on the first postoperative day was significantly higher in those who fasted (146.20 ± 38.36 mg/dl) than in those who received the energy drink (123.06 ± 26.64 mg/dl), p = 0.004. Postoperative infections were significantly higher in the control group than in the CHO group (31.43%; and 8.57%; 95% C.I: 1.23–19.47) p = 0.033. The mean length of hospital stay was longer in the FAST (12.54days ± 15.08) than in the CHO (9.17days ± 12.65) group although the difference was not statistically significant p = 0.315. The mean age, surgery type and mean duration of surgery were significant between groups but not upon logistic regression for significant clinical and demographic variables. ConclusionPreoperative CHO loading is effective and safe in reducing post-operative hyperglycaemia and infection in open general surgery even in a low resource setting.

Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery.

Three meta-analyses have summarized the effects of preoperative carbohydrate administration on postoperative outcomes in adult patients undergoing elective surgery. However, these studies could not account for the different doses of carbohydrate administered and the different controls used. Multiple-treatments meta-analysis allows robust synthesis of all available evidence in these situations. Article databases were searched systematically for RCTs comparing preoperative carbohydrate administration with water, a placebo drink, or fasting. A four-treatment multiple-treatments meta-analysis was performed comparing two carbohydrate dose groups (low, 10-44 g; high, 45 g or more) with two control groups (fasting; water or placebo). Primary outcomes were length of hospital stay and postoperative complication rate. Secondary outcomes included postoperative insulin resistance, vomiting and fatigue. Some 43 trials involving 3110 participants were included. Compared with fasting, preoperative low-dose and high-dose carbohydrate administration decreased postoperative length of stay by 0·4 (95 per cent c.i. 0·03 to 0·7) and 0·2 (0·04 to 0·4) days respectively. There was no significant decrease in length of stay compared with water or placebo. There was no statistically significant difference in the postoperative complication rate, or in most of the secondary outcomes, between carbohydrate and control groups. Carbohydrate loading before elective surgery conferred a small reduction in length of postoperative hospital stay compared with fasting, and no benefit in comparison with water or placebo.

Role of preoperative carbohydrate loading: a systematic review

INTRODUCTIONSurgical stress in the presence of fasting worsens the catabolic state, causes insulin resistance and may delay recovery. Carbohydrate rich drinks given preoperatively may ameliorate these deleterious effects. A systematic review was undertaken to analyse the effect of preoperative carbohydrate loading on insulin resistance, gastric emptying, gastric acidity, patient wellbeing, immunity and nutrition following surgery.METHODSAll studies identified through PubMed until September 2011 were included. References were cross-checked to ensure capture of cited pertinent articles.RESULTSOverall, 17 randomised controlled trials with a total of 1,445 patients who met the inclusion criteria were identified. Preoperative carbohydrate drinks significantly improved insulin resistance and indices of patient comfort following surgery, especially hunger, thirst, malaise, anxiety and nausea. No definite conclusions could be made regarding preservation of muscle mass. Following ingestion of carbohydrate drinks, no adverse events such as apparent or proven aspiration during or after surgery were reported.CONCLUSIONSAdministration of oral carbohydrate drinks before surgery is probably safe and may have a positive influence on a wide range of perioperative markers of clinical outcome. Further studies are required to determine its cost effectiveness.

Effect of preoperative carbohydrate loading on the management of blood glucose and body temperature

Effect of preoperative carbohydrate loading on the management of blood glucose and body temperature

Preoperative administration of oral carbohydrate-rich solutions: Comparison of glucometabolic responses and tolerability between patients with and without insulin resistance

Objective Preoperative carbohydrate loading with clear fluids is thought to reduce surgery-related insulin resistance (IR). However, IR per se is already present in some patients scheduled for elective surgery. Data on the safety of preoperative oral carbohydrate loading in patients with IR undergoing surgery is lacking. We aimed to evaluate the effects of preoperative carbohydrate loading on the glucometabolic state and gastric content of patients with and without IR. Methods Thirty-four non-diabetics received 800 mL of a special carbohydrate-containing drink on the evening before the operation and then 400 mL 2 h before surgery. Blood samples for glucose, insulin, and cortisol levels were taken immediately before the second dose, at 40 and 90 min after intake of the drink, and at the onset of surgery. Patients with a homeostasis model assessment IR score >2.5 were considered to have IR. The differences between patients with and without IR were then evaluated. Results Eight of the 34 patients had IR and the remaining 26 did not. Glucose levels in the IR group were higher than those in the non-IR group, but the differences did not reach significance. The initially elevated insulin concentrations then tended to decrease to the corresponding levels detected in the non-IR group. The cortisol concentrations were similar in both groups. Conclusion Patients with IR receiving a carbohydrate-rich drink before surgery appear not to be affected adversely by the beverage. Furthermore, they also obtain the probable beneficial effects related to these drinks and, like patients without IR, can undergo surgery safely.

Effects of preoperative carbohydrate loading on the changes in serum tumor necrosis factor receptors 1 and 2 and insulin resistance in patients of colon carcinoma

To investigate the effects of preoperative carbohydrate loading and new fasting protocol treatment on the postoperative changes in serum tumor necrosis factor receptor1 (sTNFR1), sTNFR2, and insulin resistance (IR) in patients of colon carcinoma. 51 patients of colon carcinoma were randomly divided into 2 groups: carbohydrate-rich beverage group (n = 24), undergoing fasting 6 h before operation and water deprivation 2 h before operation, receiving carbohydrate-rich beverage 3 h before operation and fluid therapy with glucose post-operatively, and placebo group (n = 27) undergoing routine fasting and water deprivation pre-operatively. Peripheral blood samples were collected before, during, and 1, 4, and 7 d after operation. ELISA was used to detect the sTNFR1 and sTNFR2 of preoperative, 1, 4, 7day Insulin sensitivity index (S1) was calculated. The S(1) levels at different post-operational time points of the treatment group were not significantly different from those preoperatively (all P > 0.05), while the S(1) levels of the control group decreased significantly compared to those before operation (all P < 0.05). The sTNFR1 level of the treatment group increased postoperatively and did not return to the pre-operative level 7 d after operation(all P < 0.05). The sTNFR1 levels at different post-operative time points of the treatment group were all significantly higher than those of the control group (all P < 0.05). The sTNFR2 level of the treatment group decreased postoperatively and did not return to the pre-operative level 7d after operation (all P < 0.05). The sTNFR2 levels at different post-operative time points of the treatment group were all significantly lower than those of the control group (all P < 0.05). There was not significant differences in the sTNFR1 level in the control group before and after operation (all P > 0.05). The time to first flatus and days staying in hospital of the treatment group were (77 +/- 15) hours and (11 +/- 1.2) gays respectively, both significantly shorter than those of the control group [(86 +/- 13) hours and (15.1 +/- 3.8) days respectively, both P < 0.05]. Preoperative carbohydrate loading and new fasting protocol reduce the degree and course of IR, increase the sTNFR1 level, and decrease the sTNFR2 level and days of staying in hospital.

Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: A randomized, controlled trial

Objective Despite contrary evidence, the practice of overnight fasting before elective surgery maintains its place in tradition. However, prolonged starvation, by its catabolic action, may increase the detrimental effects of surgery. In this study, we evaluated the effects of preoperative carbohydrate loading on the gastric contents of patients and perioperative metabolism. Methods Seventy patients scheduled for cholecystectomy or thyroidectomy randomly were assigned to the treatment or control group. Patients in the treatment group ( n = 34) received 800 mL of a carbohydrate-rich fluid on the evening before surgery and 400 mL of the same fluid 2 h preoperatively. Conversely, control patients ( n = 36) underwent overnight fasting. Plasma glucose and serum insulin levels were obtained across the perioperative period and during anesthesia induction. The volume and pH of preoperative residual gastric contents also were measured. Results Preoperative plasma glucose levels were found to remain significantly higher in patients who had received the carbohydrate-rich fluid. Serum insulin levels that were elevated initially in the study group returned to control levels by the time of anesthesia induction. There was no statistical difference between the two groups with respect to gastric residue contents or gastric fluid pH. Conclusion The preoperative intake of carbohydrate-rich fluids does not appear to alter the amount or pH of gastric contents, suggesting that this is a safe procedure, in terms of aspiration risk. Furthermore, the intake of such fluid might prevent energy malnutrition.

The effect of preoperative carbohydrate loading on hormonal changes, hepatic glycogen, and glucoregulatory enzymes during abdominal surgery

The effect of preoperative glucose infusion on preoperative alterations in hepatic glycogen content, the activity of key hepatic glucoregulatory enzymes (fructose 1,6-diphosphatase [FDPase]), pyruvate kinase (PK), hormonal developments, and plasma levels of free fatty acids (FFA) were investigated in 16 patients undergoing open cholecystectomy. Patients were randomized to receive (group G) or not receive (group C) overnight glucose infusion (5 mg·kg −1·d −1) preoperatively. Infusion of glucose overnight resulted in preoperative elevations of insulin and c-peptide ( P < 0.05) and lower plasma levels of FFA, while the same glucose levels were found in both groups, 4.6 mmol/L. During and after surgery, only minor changes in the plasma levels of insulin, c-peptide, catecholamines, glucagon, cortisol, growth hormone, and FFA were found, with minimal differences between groups. The hepatic glycogen content was 65% higher in group G and a significant reduction was confirmed only in this group of patients during surgery. The higher glycogen content was associated with a higher FDPase activity ratio ( P < 0.05), which remained unchanged during surgery. In contrast, a significant ( P < 0.05) increase in the activity of this enzyme was found in group C. The PK activity ratio did not differ between groups and remained unchanged during surgery. The finding of enhanced FDPase activity suggests that the indirect route (via gluconeogenesis) represents an important contributor to the increased glycogen formation during glucose infusion. Additionally, surgery in the overnight fasted patient induces enzymatic changes favoring gluconeogenesis. Lastly, preoperative high-dose glucose infusion has only minor effects on the endocrine response, plasma levels of FFA, and glycogen depletion during elective open cholecystectomy.