Are carbohydrate drinks more effective than preoperative fasting: A systematic review of randomised controlled trials

Abstract

Aims and objectives:To evaluate current evidence to determine whether oral preoperative carbohydrate drinks shorten hospital stays, reduce insulin resistance and/ or improve postoperative discomfort for patients undergoing abdominal or cardiac surgery.Background: Criticisms of standard preoperative fasting have forced practitioners to explore new ways of preparing patients for theatre. Consequently, the use of preoperative carbohydrate drinks prior to elective surgery has gained momentum. Current evidence regarding the efficacy of this treatment has been inconsistent and contradictory which prompted a review of the current literature. Design: A systematic review of randomised clinical trials (RCTs). Methods: In accordance with Prisma guidelines, the review incorporated a systematic, comprehensive search of English-language-only texts published between 2001-2018. The search focused on five databases (MEDLINE, EMBASE, CINAHL, British Nursing Index and ASSIA). Reference lists of relevant systematic reviews and studies located were also hand-searched for eligibility and further references. All RCTs investigating the effect of preoperative carbohydrate drinks on adult patients undergoing cardiac or abdominal surgery were included. The review excluded RCTs conducted on patients with type 1 or 2 diabetes mellitus and patients under the age of 18. Result: The review included 22 RCTs with a total sample of 2,065 patients across thirteen countries. Nine different types of surgery were identified. No significant reductions in hospital stay were noted in 8 of the ten trials. Preoperative carbohydrate drinks significantly reduced insulin resistance and improved postoperative discomfort especially in patients undergoing laparoscopic cholecystectomy. No definite conclusion regarding the impact of preoperative carbohydrate drinks on gastric volume and gastric pH was noted. Similarly, no adverse events such as pulmonary aspiration were reported.Conclusion: Preoperative carbohydrate drinks were found to be safe and can be administered up to 2 hr before surgery. Such drinks were also found to reduce insulin resistance and improve postoperative discomfort especially in patients undergoing | 3097 NOBA ANd WAKEFIELd | AIM OF THE RE VIE WThe aim of this review was therefore to evaluate the available evidence to establish whether oral preoperative carbohydrate drinks: laparoscopic cholecystectomy. However, there is insufficient evidence to definitively conclude what impact they have on length of hospital stay.Relevance to clinical practice: Patients undergoing surgery are often required to fast from midnight, while in some extreme cases patients are fasted for up to 24 hr prior to surgery. The main purpose of asking patients to undergo this prolonged fasting is to reduce the risk of aspiration. However, there is a general consensus that this traditional practice is out of date, and it is often associated with postoperative complications. On the other hand, current evidence suggests oral intake of fluids up to 90-180 min prior to surgery...

Fasting habits over a 10-year period: An observational study on adherence to preoperative fasting and postoperative restoration of oral intake in 2 Dutch hospitals

“…33,34 Our findings have clinical implications for surgeons, anesthesiologists, nurses, and dieticians. There is a growing body of evidence suggesting that preoperative consumption of carbohydrate beverages is safe, 35 reduces postoperative insulin resistance, 35e37 positively influences well-being (eg, malaise, thirst, hunger, and weakness, 38 nausea and vomiting, 39 ) and shortens duration of hospital stay up to 1 day. 36,40,41 Moreover, preoperative consumption of carbohydrate beverages has been used in several fields of surgery.…”

“…Nurses and other health care workers should adjust their behavior and encourage patients to eat and drink as long as possible, within the limits of the applicable guidelines. 6 Although evidence shows that preoperative consumption of oral carbohydrate beverages is safe 35 and ERAS protocols include eating recommendations, 44 suggestions for translating this knowledge to daily practice are lacking. 24 Knowledge translation may be difficult in this case because patients are primarily instructed to eat sufficiently within prehabilitation programs.…”

Effects of a Preoperative Carbohydrate-Rich Drink Before Ambulatory Surgery: A Randomized Controlled, Double-Blinded Study

“…Administration of oral carbohydrate drinks before elective surgery has been proven to be safe with a positive influence on several clinical outcomes [ 10 , 12 ]. However, carbohydrate drinks are not routinely used in China due to the lack of sufficient clinical evidence in Chinese patients.…”

“…Overnight fasting from midnight on the day of surgery is still standard practice in most hospitals in China. It has now been well established that this rule is excessively strict [ 2 ]. Patients who fast overnight before surgery may experience negative metabolic, physiological, and/or psychological effects [ 3 ].…”

Jejum pré-operatório no cliente submetido a cirurgia eletiva: revisão integrativa da literatura

“…A interação positiva com a equipa, a acessibilidade a alimentos e à sua escolha e a motivação para a mudança são facilitadores para o processo de melhoria. (Noba & Wakefield, 2019;Tosun, Yara & Açikel, 2015).…”