Preoperative oral carbohydrate administration reduces postoperative insulin resistance

Nygren, Jonas; Soop, Mattias; Thorell, Anders; Efendić, S.; Nair, K. Sreekumaran; Ljungqvist, Olle

doi:10.1016/s0261-5614(98)80307-5

Cited by 274 publications

(204 citation statements)

References 22 publications

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“…Overnight treatment with intravenous glucose was shown to attenuate the decrease in muscle insulin sensitivity 36. A similar effect was later shown for oral carbohydrates solutions tailored for pre‐operative use 37. The administration of such pre‐operative oral carbohydrates raises insulin sensitivity by 50%,38 and this carries through to the post‐operative period resulting in 50% less insulin resistance.…”

Section: Metabolic Homoeostasissupporting

confidence: 52%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Scott

Baldini

Fearon

et al. 2015

Acta Anaesthesiol Scand

Self Cite

346

198

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BackgroundThe present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.MethodsThe physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.ResultsThe pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.ConclusionsEvidence‐based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

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Section: Metabolic Homoeostasissupporting

confidence: 52%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Scott

Baldini

Fearon

et al. 2015

Acta Anaesthesiol Scand

Self Cite

346

198

View full text Add to dashboard Cite

show abstract

“…150 Clinical studies conducted in small patient populations reported better outcomes with preoperative nutrition 112,130,[151][152][153][154] and emphasize that avoidance of fasting makes patients less susceptible to complications and may decrease hospital length of stay. 27,[154][155][156] In contrast, the results of a larger randomized controlled trial showed no significant benefit. 157 A recent meta-analysis, however, suggests that preoperative administration of oral carbohydrates accelerates recovery after major abdominal surgery.…”

Section: Assessment Of Catabolism Before Surgerymentioning

confidence: 90%

Perioperative catabolism

Schricker

Lattermann

2015

Can J Anesth/J Can Anesth

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“…9 Ingesting a clear carbohydrate drink containing a relatively high concentration of complex carbohydrates two to three hours before surgery reduces preoperative thirst, hunger, and anxiety 10 and has the added advantage of reducing postoperative insulin resistance. 11 Within 90 min, 400 mL of a clear 12.5% carbohydrate drink containing mainly maltodextrins (with no fat or protein) empties completely from the stomach and, therefore, can safely be given up to two hours before induction of anesthesia. 12,13 The combination of these preoperative techniques enables the patient to come to the operating room in a ''fed'' state.…”

Section: Preoperative Fluid Managementmentioning

confidence: 99%

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

230

137

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Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a ''zero-balance'' approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and ''permissive oliguria'' could be tolerated.Résumé La gestion périopératoire optimale des liquides est un élément important des programmes de récupération rapide après la chirurgie (RRAC). La gestion des liquides dans le cadre de la RRAC doit être vue comme un continuum au travers des phases pré-, per-et postopératoires. Chaque phase est importante pour améliorer la condition du patient et des soins sous-optimaux au cours d'une de ces phases peuvent miner les meilleures pratiques déployées tout au long de la RRAC. L'objectif de la gestion préopératoire des liquides est de faire en sorte que le patient entre en salle d'opération correctement hydraté et dans un état euvolémique. Pour y parvenir, un jeûne prolongé n'est pas recommandé et le nettoyage mécanique de l'intestin est à éviter. Les patients doivent être encouragés à absorber une boisson claire riche en hydrates de carbone, deux à trois heures avant la chirurgie. Les buts de la gestion peropératoire des liquides sont de maintenir une euvolémie centrale et d'éviter un excès de sel et d'eau. Pour y parvenir, les patients subissant une intervention chirurgicale dans le cadre d'un protocole de récupération rapide devraient avoir un programme personnalisé de gestion des liquides. Dans le cadre de ce plan, l'excès de cristalloïdes doit être évité chez tous les patients. Pour des patients à faible risque subissant une intervention c...

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Preoperative oral carbohydrate administration reduces postoperative insulin resistance

Cited by 274 publications

References 22 publications

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Perioperative catabolism

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

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