Mustafa Emre GÜRCÜ, Atakan ERKILINÇ, Füsun GÜZELMERİÇ, Ömer Faruk ŞAVLUK, Halide OĞUŞ, Tuncer KOÇAK, Mehmet Ali KUŞÇU, Deniz ÇEVİRME

Do preoperative oral carbohydrates improve postoperative outcomesin patients undergoing coronary artery bypass grafts?

Background/aim: The aim of this prospective study was to determine whether the preoperative oral intake of carbohydrate-rich drinks by patients undergoing a coronary artery bypass graft attenuates postoperative insulin requirements, improves postoperative patient discomfort, provides inotropic support, shortens the length of the ICU stay, and shortens the duration of postoperative mechanical ventilation. Materials and methods: This randomized prospective clinical study included 152 patients with coronary artery disease who were divided into 4 groups. Carbohydrates were administered to 3 groups at different hours and doses before operation. The fourth group had an 8-h preoperative fasting period. The inotropic and vasopressor requirements, ventilation time, and ICU stay time were recorded for all of the groups. Patient wellbeing, mouth dryness, hunger, anxiety, and nausea were assessed using VAS scores of 1 10. Results: Mouth dryness and hunger were significantly higher in the control group (P = 0.03, P = 0.02). The increase in blood glucose level was significantly higher in the control group (P = 0.04). The exogenous insulin requirement was significantly higher in the control group than in the other groups (P = 0.04). Conclusion: The administration of carbohydrates before elective cardiac surgery reduced insulin resistance. Based on the VAS scores, the intake of carbohydrates reduced mouth dryness and hunger. Overall, preoperative oral carbohydrate treatments can improve the postoperative outcomes of coronary artery bypass graft surgeries.

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1. Wolf AR. Effect of regional analgesia on stress responses to pediatric surgery. Pediatr Anaesth 2012; 22: 19-24.
2. Ljungqvist O, Soreide E. Preoperative fasting. Br J Surg 2003; 90: 400-406.
3. Tsubo T, Kudo T, Matsuki A, Oyama T. Decreased glucose utilisation during prolonged anaesthesia and surgery. Can J Anaesth 1990; 37: 645-649.
4. Mizock BA. Blood glucose management during critical illness. Rev Endocr Metab Disord 2003; 4: 187-194.
5. Jakob SM, Ensinger H, Takala J. Metabolic changes after cardiac surgery. Curr Opin Clin Nutr Metab Care 2001; 4: 149-155.
6. Lazar HJ, Philippides G, Fitzgerald C, Lancaster D, Shemin RJ, Apstein C. Glucose-insulin-potassium solutions enhance recovery after urgent coronary artery bypass grafting. J Thorac Cardiovasc Surg 1997; 113: 354-362.
7. Lolley DM, Myers WO, Ray JF, Sautter RD, Tewksbury DA. Clinical experience with preoperative myocardial nutrition management. J Cardiovasc Surg 1985; 26: 236-243.
8. Nygren J, Thorell A, Jacobsson H, Larsson S, Schnell PO, Hylen L, Ljungqvist O. Preoperative gastric emptying: effect of anxiety and oral carbohydrate administration. Ann Sur 1995; 222: 728-734.
9. Nygren J, Soop M, Thorell A, Efendic S, Nair KS, Ljungqvist O. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nutr 1998; 17: 65-71.
10. Hausel J, Nygren J, Lagerkranser M, Hellstrom PM, Hammarqvist F, Almstrom C, Lindh A, Thorell A, Ljungqvist O. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth-Analg 2001; 93: 1344-1350.
11. Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF. Preoperative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis 2006; 8: 563-569.
12. Mathur S, Plank LD, McCall JL, Shapkov P, McIlroy K, Gillanders LK, Merrie AE, Torrie JJ, Pugh F, Koea JB et al. Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Br J Surg 2010; 97: 485- 494.
13. Gungor N, Saad R, Janosky J, Arslanian S. Validation of surrogate estimates of insulin sensitivity and insulin secretion in children and adolescents. J Pediatr 2004; 144: 47-55.
14. Nygren J. The metabolic effects of fasting and surgery. Best Pract Res Clin Anaesthesiol 2006; 20: 429-438.
15. Floh AA, Manlhiot C, Redington AN, McCrindle BW, Clarizia NA, Caldarone CA, Schwartz SM. Insulin resistance and inflammation are a cause of hyperglycemia after pediatric cardiopulmonary bypass surgery. J Thorac Cardiovasc Surg 2015; 150: 505-506.
16. Farrer M, Fulcher G, Albers CJ, Neil HA, Adams PC, Alberti KG. Patients undergoing coronary artery bypass graft surgery are at high risk of impaired glucose tolerance and diabetes mellitus during the first postoperative year. Metabolism 1995; 44: 1016-1027.
17. Rapp-Kesek D, Stridsberg M, Andersson LG, Berne C, Karlsson T. Insulin resistance after cardiopulmonary bypass in the elderly patient. Scand Cardiovasc J 2007; 41: 102-108.
18. Jarvela K, Maaranen P, Sisto T. Preoperative oral carbohydrate treatment before coronary artery bypass surgery. Acta Anaesthesiol Scand 2008; 52: 793-797.
19. Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Curr Opin Anaesthesiol 2015; 28: 364- 369.
20. Breuer JP, Von Dossow V, Von Heymann C. Preoperative oral carbohydrate administration to ASA III-IV patients undergoing elective cardiac surgery. Anaesth Analg 2006; 103: 1099-1108.
21. Oldfield GS, Commerfold PJ, Opie LH. Effect of preoperative glucose-insulin-potassium on myocardial glycogen levels and on complications of mitral valve replacement. J Thorac Cardiovasc Surg 1986; 91: 874-878.
22. Hess ML, Okabe E, Poland J, Warner M, Stewart JR, Greenfield LJ. Glucose-insulin-potassium protection during the course of hypothermic global ischemia and reperfusion: a new proposed mechanism by the scavenging of free radicals. J Cardiovasc Pharmacol 1983; 5: 35-43.
23. Leidtke AJ. Lipid burden in ischemic myocardium. J Moll Cell Cardiol 1988; 20: 65-74.
24. 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. Br J Surg 2005; 92: 415-421.
25. Helminen H, Vitanen H, Sajanti J. Effect of preoperative intravenous carbohydrate loading on preoperative discomfort in elective surgery patients. Eur J Anaesthesiol 2009; 26: 123- 127.
26. Henriksen MG, Hessov I, Dela F. Effect of preoperative oral carbohydrate and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery. Acta Anaesthesiol Scand 2003; 47: 191- 199.