Comparative Study Between Conventional Fasting Versus Overnight Infusion of Lipid or Carbohydrate on Insulin and Free Fatty Acids in Obese Patients Undergoing Elective On-pump Coronary Artery Bypass Grafting. A Prospective Randomized Trial

Hosny, Hisham; Ibrahim, Mohamed Yousif; El-Siory, Wael; Abdelmonem, Amr

doi:10.1053/j.jvca.2017.11.020

Cited by 6 publications

(3 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Twenty-seven trials reported the FPG of patients after surgery, involving 1886 participants ( 30 – 37 , 40 – 50 , 56 – 65 ). Compared with the control groups, preoperative carbohydrate loading had no significant effect on postoperative FPG.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials

et al. 2022

View full text Add to dashboard Cite

BackgroundPreoperative carbohydrate loading is an important element of the enhanced recovery after surgery (ERAS) paradigm in adult patients undergoing elective surgery. However, preoperative carbohydrate loading remains controversial in terms of improvement in postoperative outcomes and safety. We conducted a Bayesian network meta-analysis to evaluate the effects and safety of different doses of preoperative carbohydrates administrated in adult patients after elective surgery.MethodsMEDLINE (PubMed), Web of Science, EMBASE, EBSCO, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure (CNKI) were searched to identify eligible trials until 16 September 2022. Outcomes included postoperative insulin resistance, residual gastric volume (RGV) during the surgery, insulin sensitivity, fasting plasma glucose (FPG), fasting serum insulin (Fin) level, the serum levels of C-reactive protein (CRP), postoperative scores of pain, patients’ satisfaction, thirst, hunger, anxiety, nausea and vomit, fatigue, and weakness within the first 24 h after surgery and the occurrences of postoperative infection. The effect sizes were estimated using posterior mean difference (continuous variables) or odds ratios (dichotomous variables) and 95 credible intervals (CrIs) with the change from baseline in a Bayesian network meta-analysis with random effect.ResultsFifty-eight articles (N = 4936 patients) fulfilled the eligibility criteria and were included in the meta-analysis. Both preoperative oral low-dose carbohydrate loading (MD: –3.25, 95% CrI: –5.27 to –1.24) and oral high-dose carbohydrate loading (MD: –2.57, 95% CrI: –4.33 to –0.78) were associated with postoperative insulin resistance compared to placebo/water. When trials at high risk of bias were excluded, association with insulin resistance was found for oral low-dose carbohydrate loading compared with placebo/water (MD: –1.29, 95%CrI: –2.26 to –0.27) and overnight fasting (MD: –1.17, 95%CrI: –1.88 to –0.43). So, there was large uncertainty for all estimates vs. control groups. In terms of safety, oral low-dose carbohydrate administration was associated with the occurrences of postoperative infection compared with fasting by 0.42 (95%Crl: 0.20–0.81). In the other outcomes, there was no significant difference between the carbohydrate and control groups.ConclusionAlthough preoperative carbohydrate loading was associated with postoperative insulin resistance and the occurrences of postoperative infection, there is no evidence that preoperative carbohydrate administration alleviates patients’ discomfort.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022312944].

show abstract

Section: Resultsmentioning

confidence: 99%

“…Twenty-two studies were included, with data available for 1,379 participants ( 9 , 29 , 30 , 33 , 34 , 36 – 46 , 48 – 50 , 61 , 64 , 65 ). Compared with placebo or water, high-dose carbohydrate loading before surgery was associated with a decrease in Fin level (MD, –5.53 [95%Crl, –10.61 to –0.62]).…”

Section: Resultsmentioning

confidence: 99%

Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The association of FFA levels before CABG with the development of a combined endpoint that we have revealed may have a specific clinical significance, since this level can be influenced during preoperative preparation of patients. For example, a study by Hosny et al [30] showed that preoperative nocturnal lipid emulsion infusion resulted in significantly lower pre-induction FFAs, lower blood glucose and insulin levels, and lower postoperative serum TG and very-low-density lipoprotein levels compared to conventional preoperative fasting. This was also accompanied by a reduced need for postoperative inotropic support in the lipid infusion group.…”

Section: Discussionmentioning

confidence: 99%

The Role of Insulin Resistance in the Development of Complications after Coronary Artery Bypass Grafting in Patients with Coronary Artery Disease

Sumin,

Bezdenezhnykh,

Bezdenezhnykh

et al. 2023

Biomedicines

View full text Add to dashboard Cite

The aim of the study was to investigate the effect of carbohydrate metabolism disorders and insulin resistance indices on the immediate results of coronary artery bypass grafting (CABG). Method. Patients with coronary artery disease who underwent CABG (n = 383) were examined to determine glycemic status, free fatty acid and fasting insulin levels, and insulin resistance indices (Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), McAuley index, Quantitative Insulin Sensitivity Check Index (QUICKI), Revised-QUICKI). Patients were assessed for the development of perioperative complications and their length of stay in the hospital. Two groups were formed: group 1, patients with a combined endpoint (CEP, any complication and/or duration of hospital stay >10 days), n = 291; and group 2 (n = 92) without a CEP. Perioperative characteristics were analyzed, and predictors of hospital complications and prolonged hospital stay were evaluated. Results. Patients in the CEP group were older, and there were more women among them (p = 0.003). Additionally, in this group, there were more patients with diabetes mellitus (37.5% vs 17.4%, p < 0.001), obesity (p < 0.001), and a higher percentage of combined operations (p = 0.007). In the group with a CEP, the levels of glucose (p = 0.031), glycated hemoglobin (p = 0.009), and free fatty acids (p = 0.007) and the Revised-QUICKI (p = 0.020) were higher than in the group without complications. In a regression analysis, the independent predictors of complications were combined operations (p = 0.016) and the predictors of a long hospital stay (>14 days) were female gender, the left atrium size, and diabetes mellitus (p < 0.001). The predictors of a composite endpoint included female gender, age, the left atrium size, and free fatty acid levels (p < 0.001). Conclusions: In the group with in-hospital complications after CABG, not only was the presence of diabetes mellitus more often detected, but there were also higher levels of free fatty acids and a higher Revised-QUICKI. Therefore, additional assessments of insulin resistance and free fatty acid levels are advisable in patients before CABG.

show abstract

The Effect of Preoperative Oral Carbohydrate Administration on Insulin Resistance and Comfort Level in Patients Undergoing Surgery

Onalan¹,

Andsoy²,

Ersoy³

2019

Journal of PeriAnesthesia Nursing

View full text Add to dashboard Cite

Comparative Study Between Conventional Fasting Versus Overnight Infusion of Lipid or Carbohydrate on Insulin and Free Fatty Acids in Obese Patients Undergoing Elective On-pump Coronary Artery Bypass Grafting. A Prospective Randomized Trial

Cited by 6 publications

References 29 publications

Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials

Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials

The Role of Insulin Resistance in the Development of Complications after Coronary Artery Bypass Grafting in Patients with Coronary Artery Disease

The Effect of Preoperative Oral Carbohydrate Administration on Insulin Resistance and Comfort Level in Patients Undergoing Surgery

Contact Info

Product

Resources

About