Ameliyat öncesi oral karbonhidrat yüklemesinin kanıta dayalı değeri

Çok eski bir gelenek olan cerrahi hastalarında ameliyat öncesi gece yarısından itibaren oral alımının kesilmesi uygulamasının yerini, son yıllarda daha liberal beslenme rejimleri almıştır. Günümüzde berrak sıvıların ameliyattan 2 saat öncesine kadar alınmasının gastrik sıvının aspirasyonu riskini artırmadığı genel olarak kabul görmektedir. Preoperatif dönemde oral karbonhidrat yüklemesinin, cerrahi stres ve uzamış açlığın yarattığı metabolik dengesizlikleri düzeltebileceği bildirilmektedir. Bu derlemede, çağdaş literatür verilerine dayanılarak ve kanıta dayalı tıp konsepti çerçevesinde, uygulamanın güvenilirliği ve perioperatif hasta bakımındaki değeri incelenmiştir. Yüksek karbonhidratlı içeceklerin, cerrahiye bağlı insülin direncini azalttığı, katabolik süreçleri yavaşlattığı, immün mekanizmaları güçlendirdiği ve bu kazanımların kliniğe yansıması ile perioperatif hasta konforu ve derlenmeye olumlu yönde katkıda bulunduğu yönündeki savlar değerlendirilmiştir. Verilerin bilimsel kanıt düzeyleri de dikkate alındığında, uygulama ile ilgili olarak aşağıdaki çıkarımları yapmak mümkündür: 1. Karbonhidratların preoperatif infüzyonu ile hastaların metabolik dengesi üzerine olumlu katkılar sağlamak mümkün görünmektedir. Özellikle açık kalp cerrahisine giden hastalarda bu konuda daha somut veriler elde edilmiştir. 2. Oral karbonhidrat yüklemesi, hastalarda aspirasyon riskini artırmaksızın uygulanabilir. 3. Uygulamanın insülin duyarlılığını artırdığına dair kanıt mevcuttur, ancak cerrahiye bağlı insülin direncinin önemli komponenti olan non-oksidatif glikoz kullanımını düzelttiği gösterilememiştir. 4. Protein metabolizmasını olumlu yönde etkilediği yönünde sınırlı veri mevcuttur. 5. Postoperatif dönemde immün sistem üzerine olumlu etkileri olduğu yönünde sınırlı veri mevcuttur. 6. Hastaların preoperatif susuzluk hissini azaltabilmektedir, ancak diğer hasta konforu parametreleri açısından yararı tartışmalıdır. 7. Postoperatif morbiditeyi azalttığına dair sonuçlar tartışmalıdır ve bu konu yeni randomize çalışmaların odağını oluşturmalıdır.

Evidence-based value of preoperative oral carbohydrate loading

In recent years, preoperative overnight fasting, an old tradition in perioperative patient care, has largely been replaced by more liberal feeding regimens. Today, it is well-accepted that clear fluids may be ingested until two hours prior to surgery without increasing the risk for aspiration of gastric content. It has been suggested that oral carbohydrate loading could have a positive effect on metabolic alterations caused by surgical stress and prolonged starvation. In this review, based on the current literature data and the concept of evidence-based medicine, the safety and value of the application is evaluated. The paper discusses the hypotheses that these beverages: a) attenuate surgery-induced insulin resistance, b) slow down the rate of catabolic process, c) augment immune mechanisms, thereby improving patient comfort and recovery. Considering the evidence levels of the available data, the following conclusions can also be proposed: 1. Preoperative infusion of carbohydrate solutions may have some positive effects on metabolic derangements particularly for patients undergoing open heart surgery. 2. Oral carbohydrate loading may be used without increasing the risk of aspiration. 3. There is evidence that the application increases insulin sensitivity. However, the existing data does not show an improvement in the non-oxidative glucose disposal, the main component of surgery-induced insulin resistance. 4. There is limited evidence that the application positively affects protein metabolism. 5. There is limited evidence that the application positively affects immune system postoperatively. 6. It may diminish thirst, but it is controversial whether it also improves other parameters as to the patient comfort. 7. It is controversial whether the application decreases the likelihood of developing morbidity. Randomized-controlled trials in the future should be focused on the latest issue.

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Anestezi Dergisi-Cover
  • ISSN: 1300-0578
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1993
  • Yayıncı: Betül Kartal
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