Effects of Preoperative Glucose (Dextrose/Carbohydrate) Administration via Intravenous versus Oral Route on Recovery Outcome in the Post-anesthesia Care Unit
Abstract
Background: Human body exposure to any trauma, such as surgical procedures stimulates neurohumoral and catabolic responses. This process includes; increased metabolism of proteins, carbohydrates, and lipids along with water and sodium retention, resistance to insulin, and furthermore, increased levels of blood sugar. One of the factors that has been assumed to influence postoperative complications is preoperative fasting duration.
Methods: In this double-blind, randomized clinical trial, 90 patients aged 18 to 70 years, referred for elective surgery were randomly allocated to three groups of 30. Group A (IV-CHO): Within 6 hours of fasting, this group was treated with one gram per kilogram of carbohydrate dissolved in 50 ml of normal saline and then injected. Group B (Oral-CHO): Within 6 hours of fasting, this group was treated with one gram per kilogram of carbohydrate dissolved in 50 ml of normal saline and then administered orally. Group C (Ni-CHO): Within 6 hours of fasting, 50 ml of normal saline was administrated orally in this group. Patients were requested to score their pain following the surgical procedure using a scale of 0-10 scoring (VAS). Besides, the [need for] analgesics before [transfer] to the general ward, at the end of recovery stay were recorded as well.
Results: According to the results of our study, evaluation (and) comparison of VAS scores was significantly different among groups prior to the surgical procedure (p=0.004). Postoperative pain assessments showed significant difference among groups (p=0.002). Scheffe test showed significantly less pain score in the IV-CHO group than the oral-CHO (p=0.029) and control group (p=0.010).
Conclusion: Preoperative use of carbohydrate whether intravenously or orally could efficiently affect postoperative adverse effects in a positive manner while some aspects were not statistically changed to a more desirable status.
2. Haga Y, Wada Y, Takeuchi H, Ikejiri K, Ikenaga M, Kimura O. Evaluation of modified estimation of physiologic ability and surgical stress in gastric carcinoma surgery. Gastric cancer. 2012; 15(1):7-14.
3. Juni RP, Duckers HJ, Vanhoutte PM, Virmani R, Moens AL. Oxidative stress and pathological changes after coronary artery interventionsJ Am Coll Cardiol. 2013; 61(14):1471-81.
4. Liu J, Ma C, Elkassabany N, Fleisher LA, Neuman MD. Neuraxial anesthesia decreases post-operative systemic infection risk compared to general anesthesia in knee arthroplasty. Anesth Analg. 2013; 117(4):1010-6.
5. Bayazit EG, Karaaslan K, Ozturan K, Serin E, Kocoglu H. Effect of epidural levobupivacaine and levobupivacaine with fentanyl on stress response and postoperative analgesia after total knee replacement. Int J Clin Pharmacol Ther. 2013; 51(8):652-9.
6. Çeliksular MC, Saraçoğlu A, Yentür E. The influence of oral carbohydrate solution intake on stress response before total hip replacement surgery during epidural and general anaesthesia. Turk J Anaesthesiol Reanim. 2016; 44(3):117-23.
7. Ljungqvist O, Thorell A, Gutniak M, Häggmark T, Efendic S. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance. J Am Coll Surg. 1994; 178(4):329-36.
8. Yilmaz N, Çekmen N, Bilgin F, Erten E, Özhan MÖ, Coşar A. Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to preoperative fasting. Journal of research in medical sciences. J Res Med Sci. 2013;18(10):827-32.
9. Lauwick S, Kaba A, Maweja S, Hamoir E, Joris JL. Effects of oral preoperative carbohydrate on early postoperative outcome after thyroidectomy. Acta Anaesthesiol Belg. 2009; 60(2):67-73.
10. Doo AR, Hwang H, Ki M-J, Lee J-R, Kim D-C. Effects of preoperative oral carbohydrate administration on patient well-being and satisfaction in thyroid surgery. Korean J Anesthesiol. 2018; 71(5):394-400.
11. Akbarzadeh M, Eftekhari MH, Shafa M, Alipour S, Hassanzadeh J. Effects of a New Metabolic Conditioning Supplement on Perioperative Metabolic Stress and Clinical Outcomes: A Randomized, Placebo-Controlled Trial. Iran Red Crescent Med J. 2016; 18(1):e26207.
12. Doo AR, Hwang H, Ki MJ, Lee JR, Kim DC. Effects of preoperative oral carbohydrate administration on patient well-being and satisfaction in thyroid surgery. Korean J Anesthesiol. 2018; 71(5):394-400.
13. Bilku D, Dennison A, Hall T, Metcalfe M, Garcea G. Role of preoperative carbohydrate loading: a systematic review. The Annals of The Royal College of Surgeons of England. 2014; 96(1):15-22.
14. Bamgbade Kielhorn BA, Senagore AJ, Asgeirsson T. The benefits of a low dose complex carbohydrate/citrulline electrolyte solution for preoperative carbohydrate loading: focus on glycemic variability. The American Journal of Surgery. 2018; 215(3):373-6.
15. Kaška M, Grosmanová Tá, Havel E, Hyšpler R, Petrová Z, Brtko M, et al. The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery–a randomized controlled trial. Wiener klinische Wochenschrift. 2010;122(1-2):23-30.
16. Bisgaard T, Kristiansen V, Hjortsø N, Jacobsen L, Rosenberg J, Kehlet H. Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy. British journal of surgery. 2004; 91(2):151-8.
17. Henriksen M, Hessov I, Dela F, Vind Hansen H, Haraldsted V, Rodt SÅ. Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery. Acta anaesthesiologica scandinavica. 2003;47(2):191-9.
18. Hausel J, Nygren J, Lagerkranser M, Hellström PM, Hammarqvist F, Almström C, et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesthesia & Analgesia. 2001;93(5):1344-50
19. Hausel J, Nygren J, Thorell A, Lagerkranser M, Ljungqvist O. Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. British Journal of Surgery: Incorporating European Journal of Surgery and Swiss Surgery. 2005; 92(4):415-21.
20. Çakar E, Yilmaz E, Çakar E, Baydur H.The Effect of Preoperative Oral Carbohydrate Solution Intake on Patient Comfort: A Randomized Controlled Study. J Perianesth Nurs. 2017; 32(6):589-599..
21. Ömer Faruk ŞAVLUK1, Mehmet Ali KUŞÇU1, FG, MEG, ERKILINÇ1 A, DÇ, et al. Do preoperative oral carbohydrates improve postoperative outcomes in patients undergoing coronary artery bypass grafts? Turkish Journal of Medical Sciences 2017; 47:1681-6.
22. Kehlet TBVBKNCHLSJJRH. Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy. British Journal of Surgery. 2004; 91(2):151-8.
23. Mathur S1, Plank LD, McCall JL, Shapkov P, McIlroy K, Gillanders LK,et al. Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Br J Surg. 2010; 97(4):485-94.
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Issue | Vol 5 No 4 (2019): Autumn | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/aacc.v5i4.1449 | |
Keywords | ||
Intravenous carbohydrate Oral carbohydrate Post-anesthesia care unit |
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