Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy

Abstract

CHO may have a beneficial effect on PONV 12-24 h after laparoscopic cholecystectomy.

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

“…This allows for better use of any nutritional care post‐operatively, with less risk of hyperglycaemia and improved retention of protein and preservation of lean body mass 40. Studies conducted in relatively small patient populations suggested better outcomes with pre‐operative complex carbohydrates given orally up to 2 h before anaesthesia and surgery,41, 42 However, a meta‐analysis43 and a recent Cochrane analysis44 of all available data from randomised controlled trials suggest that in major abdominal surgery there is clinical impact as evidenced by faster recovery43, 44 (reduced length of stay by 1–1.5 days43). However, for minor surgery the benefit is mainly in patient well‐being,41 and in other types of surgeries the data remain sparse 44.…”

“…Studies conducted in relatively small patient populations suggested better outcomes with pre‐operative complex carbohydrates given orally up to 2 h before anaesthesia and surgery,41, 42 However, a meta‐analysis43 and a recent Cochrane analysis44 of all available data from randomised controlled trials suggest that in major abdominal surgery there is clinical impact as evidenced by faster recovery43, 44 (reduced length of stay by 1–1.5 days43). However, for minor surgery the benefit is mainly in patient well‐being,41 and in other types of surgeries the data remain sparse 44. Many National and International Anaesthetic Societies recommend a 6‐h pre‐operative fast for solids and a 2‐h fast for clear liquids, including carbohydrate drinks 44, 45, 46, 47…”

Perioperative catabolism

“…142 Overnight treatment with glucose prevents postoperative decrease in insulin sensitivity 30,146 and early loss of protein after gastrointestinal surgery [147][148][149] and augments voluntary muscle function. 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.…”

Ingestão pré-operatória de carboidratos diminui a ocorrência de sintomas gastrointestinais pós-operatórios em pacientes submetidos à colecistectomia

“…Notadamente, a diminuição da resistência periférica à insulina e da reação citoquínica inflamatória após a oferta de CHO no pré-operatório já foram bem documentadas 2,7,12 . No presente estudo, as alterações metabólico-inflamatórias não foram investigadas, pois ele enfocou as manifestações gastrointestinais, bastante comuns no pós-operatório.…”

“…Além disso, os protocolos conservadores de jejum causam aos pacientes conseqüências como sede, desidratação, irritabilidade, ansiedade, fraqueza e fome 5 . Atualmente, não existe mais base científica que sustente a conduta do jejum noturno ("nada pela boca") para pacientes candidatos a operações eletivas 5,6,7,8 . A oferta de nutrientes como a de carboidratos (CHO) no pré-operatório imediato vem sendo vista como um dos fatores benéficos para minimizar a resposta orgânica ao estresse cirúrgico e melhorar o bem estar do paciente.…”