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

Onalan, Emine; Andsoy, İşıl Işik; Ersoy, Ömer Faik

doi:10.1016/j.jopan.2018.07.007

Cited by 21 publications

(13 citation statements)

References 27 publications

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“…Nygren et al found in the 1990s that the administration of preoperative carbohydrates could improve postoperative IR more effectively than ordinary liquids (5). Onalan et al showed that preoperative oral carbohydrates improved postoperative IR of patients receiving laparoscopic cholecystectomy (LC) (6).…”

Section: Original Articlementioning

confidence: 99%

A clinical study of preoperative carbohydrate administration to improve insulin resistance in patients with multiple injuries

Shan

et al. 2020

Ann Palliat Med

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Background: The purpose of this study was to investigate the tolerance and safety of carbohydrate administration to patients with multiple injuries prior to surgery, and to analyze the effects of carbohydrate intake on their immediate insulin resistance (IR), postoperative complications, and length of hospital stay. Methods: A total of 125 patients with mild multiple injuries who were admitted to the Emergency Surgery Department of Affiliated Hospital of Nantong University for elective surgery were randomized to administration of either placebo or carbohydrate. Finally, 82 patients (male: 39, female: 43) successfully completed the experiment and collected data. Preoperative general condition, subjective comfort, blood glucose concentration, serum insulin and insulin resistance index (IR) were studied. Results: The two groups of patients matched in gender, age, body mass index (BMI) (P>0.05). Patients in CHO group treated with carbohydrates three hours before surgery compared with patients treated with preoperative specification. The thirst, hunger and anxiety of the patients in the CHO group were significantly relieved (P<0.05). Blood glucose concentration, serum insulin, and IR were much lower in the CHO group (P<0.05).Conclusions: It is a relatively safe approach that patients took carbohydrates 3 hours before surgery, and there was no statistically significant difference in the incidence of postoperative aspiration. Taking carbohydrates before surgery can not only relieve preoperative discomfort, but also reduce postoperative insulin resistance, which is helpful to avoid postoperative metabolic disorder and speed up recovery.

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Section: Original Articlementioning

confidence: 99%

A clinical study of preoperative carbohydrate administration to improve insulin resistance in patients with multiple injuries

Shan

et al. 2020

Ann Palliat Med

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“…Therefore, protective interventions seem necessary against these adverse reactions. It should be noted that this study was designed with the assumption that prolonged preoperative fasting time leads to insulin resistance and BS disturbance (43,44); an expectation that was not observed in our cases, as baseline BS and CRP values were normal. This finding indicates that the issue may need more attention among older patients with higher ASA classes, who were routinely scheduled early morning; these cases were excluded from the present study.…”

Section: Discussionmentioning

confidence: 81%

The Effects of Intravenous Vitamin C on Stress Response Severity in Abdominal Hysterectomy Following Prolonged Fasting Time

et al. 2021

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Background: Inevitable prolonged fasting time before surgery leads to inflammatory reactions, surgery-related stress response, and consequently unfavorable outcomes; thus, developing strategies to mitigate these consequences is crucial. Objectives: In this study, we evaluated the effect of ascorbic acid on stress response reduction in abdominal hysterectomy following prolonged fasting time. Methods: Eligible women candidates for abdominal hysterectomy following prolonged fasting time were enrolled in the study and divided into 2 groups of vitamin C [group C; 1 g intravenously (IV) before surgery] and placebo (group P). Before induction of anesthesia, C-reactive protein (CRP), mean arterial pressure (MAP), heart rate (HR), and blood sugar (BS) were measured and compared between the 2 groups at 4-point times, 24 and 48 hours immediately after extubation. Results: Finally, the data of 80 patients were included for the final analysis. A statistically significant difference was observed between the 2 groups in terms of CRP and BS values in T1 CRP serum levels; at the end of the study, CRP values were 0.5 ± 0.55 and 0.92 ± 0.69 in groups C and P, respectively (P = 0.012), and BS levels were 124.12 ± 18.11 and 152.0 ± 17.36 in groups C and P, respectively (P = 0.0001). However, this significant difference was not observed at T2 regarding CRP (P = 0.145) and BS (P = 0.135), as well as at T3 regarding CRP (P = 0.282) and BS (P = 0.213). However, according to both CRP and BS values, the trend of changes from T0 to T3 was significant in the 2 groups (P < 0.0001). Hemodynamic parameters were not significantly different between the 2 groups. No adverse event was reported in the 2 groups. Conclusions: We found that ascorbic acid could induce short-term positive effects in abdominal hysterectomy following prolonged fasting time. Obviously, the optimal dosage, timing, and specific cases that benefit the most from this intervention should be investigated.

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“…Eight studies reported postoperative scores of pain scores using a VAS, with data available on 739 participants ( 29 , 35 , 44 , 62 , 67 – 70 ). The results found no statistically significant difference after surgery ( Table 2 ).…”

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

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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].

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

Cited by 21 publications

References 27 publications

A clinical study of preoperative carbohydrate administration to improve insulin resistance in patients with multiple injuries

A clinical study of preoperative carbohydrate administration to improve insulin resistance in patients with multiple injuries

The Effects of Intravenous Vitamin C on Stress Response Severity in Abdominal Hysterectomy Following Prolonged Fasting Time

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

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