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Liu J, Dong S, Li W, Yu X, Huang S. Effect of early oral carbohydrate intake after elective Cesarean delivery on maternal body temperature and satisfaction: a randomized controlled trial. Can J Anaesth 2023; 70:1623-1634. [PMID: 37715046 DOI: 10.1007/s12630-023-02564-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/14/2023] [Accepted: 03/11/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE Although the Enhanced Recovery After Cesarean Delivery (ERAC) consensus statement provides recommendations for early postoperative drinking and eating, evidence from high-quality clinical research directly addressing parturients is sparse. Our objective was to assess if early oral carbohydrate intake after elective Cesarean delivery improves maternal recovery. METHODS In this randomized controlled trial, we enrolled parturients undergoing elective Cesarean delivery under spinal anesthesia with tympanic membrane temperatures ≤ 36.5 °C immediately upon arrival at the postanesthesia care unit. Parturients were randomized to either 100 mL of oral complex carbohydrate intake (group CC) or 10 mL of water (group C). The primary outcome was maternal tympanic membrane temperature. Other outcomes included maternal thermal comfort score, degree of shivering, satisfaction, degree of thirst and hunger, and gastric emptying assessed by ultrasonography. RESULTS We included 90 participants in the final analysis. The mean (standard deviation [SD]) maternal body temperature at 120 min after ingestion was 36.7 (0.3) °C in group CC and 36.6 (0.3) °C in group C (difference in means, 0.14 °C; 95% confidence interval, 0.02 to 0.26; P = 0.02). Furthermore, using repeated measure models, the linear trends of temperature changes over time between groups CC and C were significantly different (P = 0.04). The thermal comfort scores at 120 min after ingestion were higher in group CC than in group C (P = 0.02), and the linear trends of shivering score changes over time between groups CC and C also were different (P = 0.003). The mean (SD) visual analogue scale scores for maternal satisfaction were 84 (13) mm in group CC and 47 (20) mm in group C (P < 0.001). Nevertheless, at 90 and 120 min after ingestion, there were no differences between the two groups in the number of participants with a gastric antrum cross-sectional area > 10.3 cm2. CONCLUSIONS Early oral carbohydrate intake after Cesarean delivery helped to restore maternal body temperature postoperatively and improve maternal satisfaction. Nevertheless, the clinical importance of these finding is unclear, given that most of the differences were small. In addition, there was no delay in maternal gastric emptying after consumption of a complex carbohydrate beverage in the early post-Cesarean period. STUDY REGISTRATION www.chictr.org.cn (ChiCTR2000031085); first submitted 13 November 2022.
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Affiliation(s)
- Jingjing Liu
- Department of Anaesthesiology, Obstetrics and Gynaecology Hospital, Fudan University, 128 Shenyang Rd., Yangpu District, Shanghai, 200090, China
| | - Sulin Dong
- Department of Anaesthesiology, Obstetrics and Gynaecology Hospital, Fudan University, 128 Shenyang Rd., Yangpu District, Shanghai, 200090, China
| | - Weiyi Li
- Department of Anaesthesiology, Obstetrics and Gynaecology Hospital, Fudan University, 128 Shenyang Rd., Yangpu District, Shanghai, 200090, China
| | - Xinhua Yu
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Shaoqiang Huang
- Department of Anaesthesiology, Obstetrics and Gynaecology Hospital, Fudan University, 128 Shenyang Rd., Yangpu District, Shanghai, 200090, China.
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Zhang T, Xiong X, Qin P, Jin J. The Effect of Preoperative Oral Carbohydrate on the Incidence of Complications in PACU After General Anesthesia: A Prospective Cohort Study. J Perianesth Nurs 2023; 38:83-87. [PMID: 35970661 DOI: 10.1016/j.jopan.2022.05.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE This study aimed to investigate the effect of preoperative oral carbohydrate (POC) loading on the occurrence of complications in the postanesthesia care unit (PACU) after general anesthesia. DESIGN Prospective observational cohort study METHODS: Patients who were scheduled for abdominal surgery under general anesthesia at our institution were divided into the POC group and control group based on whether they drank carbohydrate solution 2 hours before surgery. POC loading of the patients was decided by the responsible surgeon. In PACU, the occurrence of postoperative complications including delayed emergence, emergence agitation, hypoxemia, hypertension, hypotension, moderate to severe postoperative pain, nausea and vomiting, hypothermia, shivering, and time to awakening, time to extubation, length of PACU stay were recorded. FINDINGS Data from 307 patients (n = 154 in POC group and n = 153 in control group) were included in the final analysis. Compared to the control group, POC led to a near-significant reduction in the overall incidence of complications in PACU after surgery (37.0% vs 47.7%, P = .058). The POC group had a lower incidence of hypothermia and shorter mean time to awakening when compared to control group (6.5% vs 16.3%, P = .007 and 19 min vs 21 min, P = .007, respectively). No statistical differences were detected in other outcome measurements between the POC group and the control group. CONCLUSIONS POC is associated with a trend to decrease the overall incidence of complications during recovery period after general anesthesia in patients who underwent abdominal surgery. Moreover, POC could reduce the risk of hypothermia in PACU and shorten the time to awakening.
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Affiliation(s)
- Ting Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Xianwei Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Peipei Qin
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Juying Jin
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University.
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Effect of Preoperative Oral Carbohydrate Loading on Body Temperature During Combined Spinal-Epidural Anesthesia for Elective Cesarean Delivery. Anesth Analg 2021; 133:731-738. [PMID: 33661781 DOI: 10.1213/ane.0000000000005447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intraoperative hypothermia is a common complication after neuraxial block in cesarean delivery. At least 1 animal study has found that carbohydrate loading can maintain the body temperature of rats during general anesthesia, but it is unclear whether carbohydrate loading is beneficial for body temperature maintenance in parturient women during combined spinal-epidural anesthesia (CSEA) for elective cesarean delivery. METHODS Women undergoing elective cesarean delivery were randomized into a control group (group C), an oral carbohydrate group (group OC), or an oral placebo group (group OP), with 40 women in each group. Core body temperature (Tc) and body surface temperature (Ts) before and after cesarean delivery, changes in Tc (ΔTc) and Ts (ΔTs), and the incidence of side effects (eg, intraoperative shivering) were compared among the groups. RESULTS The postoperative Tc (core body temperature after cesarean delivery [Tc2]) of group OC (36.48 [0.48]°C) was higher than those of group C (35.95 [0.55]°C; P < .001), and group OP (36.03 [0.49]°C; P = .001). The ΔTc (0.30 [0.39]°C) in group OC was significantly smaller than those in group C (0.73 [0.40]°C; P = .001) and group OP (0.63 [0.46]°C; P = .0048). CONCLUSIONS Oral carbohydrate loading 2 hours before surgery facilitated body temperature maintenance during CSEA for elective cesarean delivery.
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Hamamoto H, Yamamoto M, Masubuchi S, Ishii M, Osumi W, Tanaka K, Okuda J, Uchiyama K. The impact of preoperative carbohydrate loading on intraoperative body temperature: a randomized controlled clinical trial. Surg Endosc 2018; 32:4393-4401. [DOI: 10.1007/s00464-018-6273-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/07/2018] [Indexed: 12/20/2022]
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Asakura A, Mihara T, Goto T. The Effect of Preoperative Oral Carbohydrate or Oral Rehydration Solution on Postoperative Quality of Recovery: A Randomized, Controlled Clinical Trial. PLoS One 2015; 10:e0133309. [PMID: 26317629 PMCID: PMC4552663 DOI: 10.1371/journal.pone.0133309] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/25/2015] [Indexed: 12/24/2022] Open
Abstract
Background Numerous studies have demonstrated the beneficial effects of preoperative administration of oral carbohydrate (CHO) or oral rehydration solution (ORS). However, the effects of preoperative CHO or ORS on postoperative quality of recovery after anesthesia remain unclear. Consequently, the purpose of the current study was to evaluate the effect of preoperative CHO or ORS on patient recovery, using the Quality of Recovery 40 questionnaire (QoR-40). Methods This prospective, randomized, controlled clinical trial included American Society of Anesthesiologists (ASA) physical status 1 and 2 adult patients, who were scheduled to undergo a surgical procedure of body surface. Subjects were randomized to one of the three groups: 1) preoperative CHO group, 2) preoperative ORS group, and 3) control group. The primary outcome was the global QoR-40 administered 24 h after surgery. Intraoperative use of vasopressor, intraoperative body temperature changes, and postoperative nausea and vomiting (PONV) were also evaluated. Results We studied 134 subjects. The median [interquartile range (IQR)] global QoR-40 scores 24 h after the surgery were 187 [177–197], 186 [171–200], and 184 [171–198] for the CHO, ORS, and control groups, respectively (p = 0.916). No significant differences existed between the groups regarding intraoperative vasopressor use during the surgery (p = 0.475). Conclusions Results of the current study indicated that the preoperative administration of either CHO or ORS did not improve the quality of recovery in patients undergoing minimally invasive body surface surgery. Trial Registration www.umin.ac.jp UMIN000009388 https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000011029&language=E
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Affiliation(s)
- Ayako Asakura
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- * E-mail:
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Anesthesiology, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Uhlig C, Krause H, Koch T, Gama de Abreu M, Spieth PM. Anesthesia and Monitoring in Small Laboratory Mammals Used in Anesthesiology, Respiratory and Critical Care Research: A Systematic Review on the Current Reporting in Top-10 Impact Factor Ranked Journals. PLoS One 2015; 10:e0134205. [PMID: 26305700 PMCID: PMC4549323 DOI: 10.1371/journal.pone.0134205] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/07/2015] [Indexed: 11/19/2022] Open
Abstract
RATIONALE This study aimed to investigate the quality of reporting of anesthesia and euthanasia in experimental studies in small laboratory mammals published in the top ten impact factor journals. METHODS A descriptive systematic review was conducted and data was abstracted from the ten highest ranked journals with respect to impact factor in the categories 'Anesthesiology', 'Critical Care Medicine' and 'Respiratory System' as defined by the 2012 Journal Citation Reports. Inclusion criteria according to PICOS criteria were as follows: 1) population: small laboratory mammals; 2) intervention: any form of anesthesia and/or euthanasia; 3) comparison: not specified; 4) primary outcome: type of anesthesia, anesthetic agents and type of euthanasia; secondary outcome: animal characteristics, monitoring, mechanical ventilation, fluid management, postoperative pain therapy, animal care approval, sample size calculation and performed interventions; 5) study: experimental studies. Anesthesia, euthanasia, and monitoring were analyzed per performed intervention in each article. RESULTS The search yielded 845 articles with 1,041 interventions of interest. Throughout the manuscripts we found poor quality and frequency of reporting with respect to completeness of data on animal characteristics as well as euthanasia, while anesthesia (732/1041, 70.3%) and interventions without survival (970/1041, 93.2%) per se were frequently reported. Premedication and neuromuscular blocking agents were reported in 169/732 (23.1%) and 38/732 (5.2%) interventions, respectively. Frequency of reporting of analgesia during (117/610, 19.1%) and after painful procedures (38/364, 10.4%) was low. Euthanasia practice was reported as anesthesia (348/501, 69%), transcardial perfusion (37/501, 8%), carbon dioxide (26/501, 6%), decapitation (22/501, 5%), exsanguination (23/501, 5%), other (25/501, 5%) and not specified (20/501, 4%, respectively. CONCLUSIONS The present systematic review revealed insufficient reporting of anesthesia and euthanasia methods throughout experimental studies in small laboratory mammals. Specific guidelines for anesthesia and euthanasia regimens should be considered to achieve comparability, quality of animal experiments and animal welfare. These measures are of special interest when translating experimental findings to future clinical applications.
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Affiliation(s)
- Christopher Uhlig
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Dresden, Dresden, Technische Universität Dresden, Germany
| | - Hannes Krause
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Dresden, Dresden, Technische Universität Dresden, Germany
| | - Thea Koch
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Dresden, Dresden, Technische Universität Dresden, Germany
| | - Marcelo Gama de Abreu
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Dresden, Dresden, Technische Universität Dresden, Germany
| | - Peter Markus Spieth
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Dresden, Dresden, Technische Universität Dresden, Germany
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Oda Y, Kakinohana M. Introduction of ERAS(®) program into clinical practice: from preoperative management to postoperative evaluation : Opening remarks. J Anesth 2013; 28:141-2. [PMID: 24306128 DOI: 10.1007/s00540-013-1747-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Yutaka Oda
- Department of Anesthesiology, Osaka City General Hospital and Children's Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan,
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Yatabe T, Tamura T, Yokoyama M. Effect of preoperative carbohydrate loading on the management of blood glucose and body temperature. J Anesth 2013; 28:148-51. [PMID: 24232414 DOI: 10.1007/s00540-013-1740-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Indexed: 12/20/2022]
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Preoperative oral rehydration therapy with 2.5 % carbohydrate beverage alleviates insulin action in volunteers. J Artif Organs 2013; 16:483-8. [PMID: 23917335 DOI: 10.1007/s10047-013-0722-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/22/2013] [Indexed: 02/05/2023]
Abstract
Preoperative carbohydrate loading enhances insulin action by approximately 50 %. In some Japanese hospitals, preoperative oral rehydration therapy is performed for preventing dehydration during surgery. We hypothesized that preoperative oral rehydration therapy with a 2.5 % carbohydrate beverage that is widely used in Japan can enhance insulin action. Therefore, we investigated the effect of this 2.5 % carbohydrate beverage on insulin action in volunteers. Six healthy volunteers participated in this crossover randomized study. The participants were segregated into 2 groups: an oral rehydration therapy with 2.5 % carbohydrate beverage group (group A) and a control group (group B). Subjects in group B were allowed to drink only water from 9 pm the day before the test; conversely, group A fasted from 9 pm onward and drank 500 ml of the beverage containing 2.5 % carbohydrate (OS-1; Otsuka Pharmaceutical Factory, Tokushima, Japan) between 9 and 12 pm and again at 6.30 am. At 8.30 am, a hyperinsulinemic normoglycemic clamp was initiated using an artificial pancreas STG-22 (Nikkiso, Tokyo, Japan). Insulin action was evaluated in both groups using the glucose infusion rate. Blood glucose levels at the initiation of the clamp procedure were similar. However, the glucose infusion rate for group A was significantly higher than that of group B (8.6 ± 1.5 vs. 6.8 ± 2.0 mg/kg/min, p = 0.009). In conclusion, the hyperinsulinemic normoglycemic clamp using an artificial pancreas showed that the administration of a 2.5 % carbohydrate oral rehydration solution for preoperative oral rehydration therapy improves insulin action in volunteers.
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