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Original Articles
- Preoperative consumption of a carbohydrate drink before laparoscopic cholecystectomy is safe and beneficial in Korea: a non-randomized controlled study
- Yoo Jin Choi, Yoonhyeong Byun, Seong Mi Yang, Ho-Jin Lee, Hongbeom Kim
- Ann Clin Nutr Metab 2023;15(1):15-21. Published online April 1, 2023
- DOI: https://doi.org/10.15747/ACNM.2023.15.1.15
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Abstract
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Supplementary Material - Purpose: Overnight fasting prior to elective surgery is the traditional way of avoiding the risk of aspiration during anesthesia induction. However, it causes mental and metabolic stress to patients. Therefore, we investigated the safety and potential benefits of the preoperative consumption of a carbohydrate drink.
Methods: This was a single-center prospective, nonrandomized study with questionnaire. Patients scheduled for elective laparoscopic cholecystectomy were included. There was no restriction on age, underlying diseases, and biliary drainage prior to surgery. They were preoperatively given either a carbohydrate drink or were instructed to fast from midnight before surgery. Perioperative emotional status was measured using the visual analog scale.
Results: The 132 patients completed the questionnaire, with 68 receiving the carbohydrate drink and 64 following nil per oral after-midnight instruction. There were no postoperative complications related to preoperative drink consumption or the cholecystectomy procedure itself in both groups. There were no significant differences in all the assessed feelings postoperatively except that preoperative discomforts, such as hunger and thirst, were significantly more alleviated in the group of preoperative consumption of a carbohydrate drink.
Conclusion: Preoperative consumption of a carbohydrate drink was found to be safe and effective in alleviating preoperative discomfort in elective surgery patients, including older patients and those with underlying comorbidities, who were at greater risk for aspiration. Therefore, we recommend considering preoperative drink consumption as an alternative to traditional overnight fasting in elective surgery patients.
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- Pilot Study for Safety and Efficacy of Newly Developed Oral Carbohydrate-Rich Solution Administration in Adult Surgery Patients
- Won-Bae Chang, Kyuwhan Jung, Sang-Hoon Ahn, Heung-Gwon Oh, Mi-Ok Yoon
- J Clin Nutr 2016;8(1):24-28. Published online April 30, 2016
- DOI: https://doi.org/10.15747/jcn.2016.8.1.24
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Abstract
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Purpose:
In surgical procedures under general anesthesia, 6 to 8 hours of a
nulla per os (NPO; nothing by mouth) has been regarded as essential for prevention of respiratory complication such as aspiration. However, recent studies have reported that oral intake of water and other clear fluids up to 2 hours before induction of anesthesia does not increase respiratory problems. The purpose of this pilot study is to investigate the safety and efficacy of a newly developed carbohydrate-rich solution in elective hernia repair surgery patients.Methods:
A group of 30 adult patients scheduled for elective surgeries under general anesthesia were enrolled. The enrolled study group of patients was permitted to drink a carbohydrate-rich solution until two hours before the operation without volume limitation. Respiratory complication was investigated in the patients using the carbohydrate-rich solution until two hours before induction of general anesthesia. The feelings of thirst, hunger sense were measured pre- and post-operatively. In addition, hoarseness of voice, nausea and vomiting were investigated post-operatively. Satisfaction regarding the short time of fasting was measured. Visual analogue scale (VAS) was used for measurement of these six variables.
Results:
No patients showed serious respiratory complication such as dyspnea, desaturation. Eight of 30 study group patients complained of mild hoarseness. Most symptoms of hoarseness were mild, with VAS score less than 3 out of 10. Two patients complained 5 out of 10. Six patients felt nausea and 1 patient had vomiting. Pre/post-operative hunger sense and thirst feeling were 1.63/1.60 and 1.90/5.76, respectively. The satisfaction score was 3.00 out of 4.
Conclusion:
Allowing the administration of an oral carbohydrate-rich solution in elective surgery patients requiring general anesthesia is safe without serious respiratory complications and effective in providing satisfaction.
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- The Evaluation of Preoperative Oral Carbohydrate-Rich Solution Effects on Insulin Resistance in Patients undergoing Colectomy
- Cherry Ann Sio, Kyuwhan Jung, Seong-Bum Kang, Duk-Woo Kim, Heung-Kwon Oh, Miok Yoon
- J Clin Nutr 2015;7(2):62-67. Published online August 31, 2015
- DOI: https://doi.org/10.15747/jcn.2015.7.2.62
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Abstract
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Purpose:
Reducing preoperative fasting time showed positive effects in several studies, and current guidelines suggest use of a preoperative oral carbohydrate-rich solution before elective surgeries. For elective colectomy procedures, some surgeons favor two-day bowel preparation with diet restriction and administration of laxatives. Aside from patients experiencing the discomfort of nil per os (NPO), there are reported benefits regarding intake of liquids until at least two hours prior to surgery, including decrease in insulin resistance, without additional postoperative surgical complications. The aim of this study is to show the benefits of administration of oral rehydration solution (ORS) two hours prior to surgery for patients undergoing elective colectomy, particularly postoperative insulin resistance.
Methods:
This is a randomized controlled trial. All patients undergoing elective colectomy were included and randomized to the control arm or treatment arm. The control arm consisted of the standard bowel preparation and one day of NPO, while the treatment arm consisted of the standard bowel preparation and allowing intake of carbohydrate-rich ORS until 2 hours before surgery. The insulin, glucose, cortisol, and triglyceride levels were determined immediately after induction, 6 hours, 24 hours, and 48 hours post-op, and compared. The homeostatic model assessment-insulin resistance, insulin, glucose, cortisol, and triglyceride levels were determined and compared between the two groups. Anxiety and postoperative complications were monitored and assessed as well.
Results:
There was less insulin resistance in patients who received ORS 2 hours prior to surgery. Insulin, glucose, cortisol, and triglyceride levels were lower in the treatment group compared to the control group. Taking ORS 1 day prior and until 2 hours before surgery decreased anxiety and discomfort, and alleviated hunger.
Conclusion:
Regarding complications, there was no difference in the incidence of aspiration and postoperative complications. There were fewer wound complications and incidence of paralytic ileus in the treatment group.
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