Hyperglycaemia reduces gastrin-stimulated gastric acid secretion in humans

Effects of perioperative dextrose infusion on preventing postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a meta-analysis of randomized controlled trials

Objective

The aim of this study was to systematically examine the literature and assess the effects of perioperative dextrose infusion on the prevention of postoperative nausea and vomiting (PONV) in patients following laparoscopic surgery under general anesthesia.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Studies were eligible for inclusion if they evaluated the prevention of PONV with perioperative intravenous dextrose. Studies listed in PUBMED, Web of Science, and EMBASE databases published up to December 2020 were identified. Data were extracted and analyzed independently using a fixed-effects or random-effects model according to the heterogeneity.

Results

Six RCTs involving 526 patients were included. Our results showed that perioperative dextrose infusion not only reduced the incidence of PONV (risk ratio [RR] = 0.61, 95% confidence interval [CI]: 0.39–0.95; I² = 59%) but also decreased the requirement for antiemetics compared with the control (RR = 0.53, 95% CI: 0.42–0.66; I² = 32%). Furthermore, perioperative glucose infusion did not increase blood glucose levels compared with the control (mean difference [95% CI] = 74.55 [−20.64 to 169.73] mg/dL; I² = 100%).

Conclusion

Our study reveals that perioperative dextrose infusion may reduce the risk of PONV after laparoscopic surgery. However, additional population-based RCTs are needed to confirm this finding.

Effects of intravenous dextrose on preventing postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis

BACKGROUND

It is reported that postoperative nausea and vomiting, common general anesthesia complications, may be prevented by perioperative intravenous dextrose administration, but with controversial clinical effectiveness.

OBJECTIVE

To evaluate perioperative intravenous dextrose for preventing postoperative nausea and vomiting through a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.

DATA SOURCES

MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, clinicaltrials.gov, and the University Hospital Medical Information Network Clinical Trials Registry were searched from inception until 22 June 2019.

ELIGIBILITY CRITERIA

Trials investigating intravenous dextrose effects vs. placebos on postoperative nausea and vomiting in patients who underwent general anesthesia.

RESULTS

Eleven trials (1,250 patients) were included. All participants were ASA1-2. The nine trials included laparoscopic surgeries, and 92.2% of the participants were women. The timing of dextrose infusion was before, during, and after surgery in three, five, and three trials, respectively. Our results revealed intravenous dextrose administration significantly reduced postoperative nausea, but not vomiting, during early and late postoperative periods (risk ratio [95% confidence interval], early nausea: 0.76 [0.59-0.99], late nausea: 0.65 [0.48-0.89]; early vomiting: 1.00 [0.81-1.25], late vomiting: 0.96 [0.43-2.16]). Evidence quality was downgraded to low because the trial sequential analysis indicated more trials are needed for firm conclusions.

CONCLUSIONS

Compared with placebos, perioperative intravenous dextrose administration may decrease postoperative nausea but not vomiting.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry (registration number: UMIN000030901).

Does perioperative intravenous dextrose reduce postoperative nausea and vomiting? A systematic review and meta-analysis

Purpose

Perioperative dextrose-containing fluid administration has been used as a non-pharmacologic preventive measure against postoperative nausea and vomiting (PONV), a common and distressing complication of anesthesia. However, its efficacy remains unclear as previous studies reported inconsistent results. Our objective was to compare dextrose-containing fluid with non-dextrose-containing fluid in terms of PONV for 24 hours after surgery under general anesthesia. The effects of dextrose according to different types of surgery and the fluid volume were also examined.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing dextrose-containing fluid with non-dextrose-containing fluids after general anesthesia in terms of PONV incidence and the need for rescue anti-emetic therapies for 24 hours after surgery. A literature search was performed, using Medline, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus, up to February 2018.

Results

We included seven RCTs. Compared with the control group, perioperative dextrose administration did not reduce the risk for PONV, with a relative risk (RR) of 0.72 (95% CI: 0.50–1.03). However, perioperative dextrose reduced the requirement for anti-emetics, compared with the control group, with a RR of 0.60 (95% CI: 0.44–0.83). The quality of evidence in this meta-analysis was poor due to high risks of selection and performance biases and substantial statistical heterogeneity. After subgroup analysis, the risk for PONV was reduced in patients who had undergone laparoscopic cholecystectomy, but not other surgeries, and the effects of dextrose on the risk for PONV did not differ according to the fluid volume administered.

Conclusion

Perioperative intravenous (i.v.) dextrose did not reduce the risk for PONV. However, it did reduce the need for anti-emetics after general anesthesia. Furthermore, the effects of dextrose varied according to the surgery type. Further studies are needed to determine the benefits of perioperative i.v. dextrose administration as a preventive measure against PONV.

The effect of intravenous dextrose administration for prevention of post-operative nausea and vomiting after laparoscopic cholecystectomy: A double-blind, randomised controlled trial

Background and Aims:

Post-operative nausea and vomiting (PONV) is a common and distressing complication after laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the effect of intravenous (IV) dextrose administration for the prophylaxis of PONV after LC.

Methods:

In a double-blind, randomised controlled trial, a total of 150 female patients who were scheduled for elective LC were randomly assigned into two groups (A and B). Thirty minutes before induction of anaesthesia, patients received an infusion of 500 cc lactated Ringer's solution (Group A) and 5% dextrose in lactated Ringer's solution (Group B) and over a period of 30 min. All patients rated their nausea and vomiting intensity using the verbal rating scale immediately at post-anaesthesia care unit (PACU) arrival; 30, 60, 90 and 120 min after arriving at the PACU and 6, 12 and 24 h after surgery.

Results:

There was a statistically significant time trend and group effect along with significant differences in time/group interaction effect in both groups for nausea and vomiting scores (P < 0.05). A low negative correlation coefficient was found (r = −0.394, P < 0.001) between blood glucose levels and nausea scores upon PACU arrival. Dextrose administration reduced the odds of vomiting events compared to placebo (estimate: −0.87, odds ratio = 0.42, 95% confidence interval: 0.28–0.64).

Conclusion:

Administration of IV dextrose before anaesthesia induction may be recommended as an effective, and safe method for the prophylaxis of PONV after LC.

Gastric stimulation in the digestive period modifies length and contractility of the inter-digestive period in obese non-diabetic and diabetic subjects

BACKGROUND

The association between phase II of the motor migratory complex (MMC) and hunger remains poorly understood, which may be important in non-diabetic and diabetic obese subjects where gastric inter-digestive motility has been often reported as impaired. We characterize phase II of the MMC and its predictive power on food intake, weight loss, and glycemia in non-diabetic (OB) and diabetic (DM) obese subjects treated with gastric stimulation for 6 months.

METHODS

Twelve OB and 12 DM subjects were implanted with bipolar electrodes connected to a gastric stimulator capable of recording antrum electromechanical activity.

RESULTS

The phase II mean interval size and duration increased from 156 ± 121 to 230 ± 228 s and from 98 ± 33 to 130 ± 35 min (p < 0.05) in OB and from 158 ± 158 to 180 ± 112 s and from 77 ± 26 to 109 ± 18 min (p < 0.05) in DM after 6 months. There was a significant trend of meals to interrupt the late rather than the early phase II. Nonlinear regression analysis demonstrated that weight loss in OB was significantly associated with the change in interval size of the late phase II and with phase II duration. In the DM group, weight loss and glycemia were also significantly associated with the change in the interval size of the early phase II.

CONCLUSIONS

Gastric stimulation delivered in the digestive period can modify the length of the MMC and the contractility in its longest component, phase II. The duration and contractility of the MMC can determine to some extent future intake and, thus, influence energy balance.

Comparison of preoperative gastric contents and serum gastrin concentrations in pregnant and nonpregnant women

STUDY OBJECTIVE

The aim of this study was to compare the volume and the pH level of preoperative gastric contents and serum gastrin concentrations between pregnant and nonpregnant women.

DESIGN

This prospective controlled study was conducted in a single blind manner.

PATIENTS

One hundred pregnant women scheduled for elective cesarean delivery (pregnant group) and 100 nonpregnant women who underwent gynecologic surgery (nonpregnant group) were enrolled.

INTERVENTIONS

Gastric content was aspirated gently with 14-F multiorificed nasogastric tube before the induction of anesthesia.

MEASUREMENTS

The volume and the pH level of the aspirated gastric contents were measured, and serum gastrin concentration was measured by the double antibody gastrin method.

MAIN RESULTS

The gastric volume in the pregnant group was greater than in the nonpregnant group (0.49 +/- 0.4 vs 0.24 +/- 0.2 mL/kg, P < .05). The gastric pH level in the pregnant group was lower than in the nonpregnant group (2.4 +/- 1.4 vs 3.0 +/- 1.9, P < .05). The number of patients at risk was 45 (45.5%) in the pregnant group and 16 (16.7%) in the nonpregnant group (P < .05). The serum gastrin levels of the 2 groups were not significantly different (32.1 +/- 12.3 vs 28.2 +/- 8.3 pg/mL). The preoperative anxiety level of the pregnant group was higher than in the nonpregnant group (4.4 +/- 2.1 vs 3.8 +/- 2.2, P < .05).

CONCLUSIONS

We confirmed that pregnant women have much greater and more acidic gastric contents than the nonpregnant patients preoperatively, and it is not because of serum gastrin concentration.

Convergence of gastric vagal and cerebellar fastigial nuclear inputs on glycemia-sensitive neurons of lateral hypothalamic area in the rat

Gastric vagal and cerebellar fastigial nuclear afferents have been implicated in the regulation of food intake by their communication with lateral hypothalamic area (LHA), which is generally referred to be the feeding center. This study was designed to examine the possible convergence of the inputs from the gastric vagal trunks and cerebellar fastigial nucleus (FN) on the LHA neurons. Among recorded 191 LHA neurons, 99 (51.8%) responded to the stimulation of the gastric vagal trunks, of which 55 (55.6%) also responded to the cerebellar FN stimulation. Of 62 LHA neurons that responded to the gastric vagal stimulation, 43 (69.4%) showed an inhibitory response to the intravenous glucose application indicating they were glycemia-sensitive neurons. When the gastric vagal trunks and cerebellar FN were stimulated simultaneously, a summation of the responses usually could be seen in the recorded LHA neurons (16/20, 80%). Moreover, of 45 LHA neurons that responded to both of the gastric vagal trunks and FN stimuli, 30 (66.7%) were identified to be glycemia-sensitive neurons. These results demonstrated that gastric vagal afferents could reach glycemia-sensitive neurons of the LHA, and that the inputs from cerebellar FN and gastric vagal trunks could converge onto glycemia-sensitive neurons in the LHA. According to the facts that gastric vagal inputs and blood glucose level may transmit meal-related visceral signals and FN may forward the somatic information to the LHA, we suggest that an integration of the somatic-visceral response related to the food intake may take place in the LHA following the gastric vagal and cerebellar FN afferent inputs and the integration may play an important role in the short-term regulation of feeding behavior.