Effects of preoperative oral enzyme-hydrolyzed rice flour solution on gastric emptying and insulin resistance in patients undergoing laparoscopic cholecystectomy: a prospective randomized controlled trial

Abstract

Background The effect of preoperative oral carbohydrates (POC) on insulin resistance (IR) of laparoscopic cholecystectomy (LC) remains debatable. Enzyme-hydrolyzed rice flour (EHR) is a kind of water-soluble micromolecular carbohydrates. This study aimed to investigate the impact of preoperative oral EHR solution on gastric emptying and IR in patients undergoing LC. Methods Patients (n = 100) undergoing LC were divided into oral-water group (group C) or oral-EHR solution (group E) randomly (n = 50 each), and the patients drank 300 ml water or EHR solution 2-3 h before surgery respectively. Gastric emptying which was quantized by gastric volume (GV) from antrum ultrasonography, IR indicators, subjective comfort indicators, handgrip strength, postoperative recovery indexes, and complications were recorded. Results There were no differences in GV between the two groups before oral administration (V0), immediately after oral administration (V1) and before anesthesia induction(V2). The GV at V2 (GV2) reduced to the level of V0 (GV0) in the two groups. Fasting glucose (FG), fasting insulin (FINS) and Homa-IR in the two groups increased at postoperative day 1 (Pos 1d) compared with those at preoperative day 1(Pre 1d). Homa-IS and Homa-β in the two groups decreased at Pos 1d compared with those at Pre 1d. FG, FINS and Homa-IR in group E were lower than those in group C at Pos 1d, and Homa-IS and Homa-β were higher in group E than those in group C at Pos 1d. Subjective comfort indictors (hunger, fatigue and anxiety) in group E were lower than those in group C at preoperative 15 min (Pre 15 min) and postoperative 1 h (Pos 1 h). Handgrip strength in group E was raised compared with that in group C at Pre 15 min, Pos 1 h and Pos 1d. There was a lower incidence of nausea and earlier exhaust time in group E. Conclusion Oral 300 ml EHR solution 2-3 h before LC surgery did not increase the occurrence of reflux and aspiration during anesthesia induction with a normal gastric emptying, ameliorated postoperative IR, improved subjective comfort, and promoted postoperative gastrointestinal function recovery. Trial registration Prospectively registered at the China Clinical Trial Registry, registration number: ChiCTR2000039939, date of registration:14/11/2020.

Preoperative fasting and the risk of pulmonary aspiration—a narrative review of historical concepts, physiological effects, and new perspectives

“…International guidelines have recommended 2-h clear liquid fasting before induction of anaesthesia in adults. 32 , 42 , 67 , 78 , 79 In clinical practice, however, adult patients fast for a median of 9–12 h. 11 , 80 , 81 , 82 , 83 , 84 Prolonged liquid deprivation not only causes discomfort such as thirst, anxiety, fatigue, and postoperative nausea, 80 , 82 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 but can also lead to serious postoperative complications. The duration of preoperative liquid fasting is a modifiable precipitating factor of delirium in the post-anaesthesia recovery room (odds ratio 2.69) and on the ward (odds ratio 10.57).…”

“…In adults, prolonged fasting resulted in perioperative hyperglycaemia, insulin resistance, increased interleukin-6 levels, urinary ketone excretion, impaired cardiac output, and psychosomatic status, and decreased muscle strength compared with drinking carbohydrate drinks 2 h before induction of anaesthesia. 91 , 93 , 95 , 98 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 Perioperative hyperglycaemia is associated with an increased risk of infection, reoperation, and mortality in patients undergoing visceral surgery. 115 Patients who drink coffee regularly have an increased risk of postoperative caffeine withdrawal headache.…”