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Maselli R, Massimi D, Ferrari C, Mondovì AN, Hassan C, Repici A. Enhanced recovery after surgery (ERAS) in advanced therapeutic flexible endoscopy: Introducing the concept of enhanced recovery after therapeutic endoscopy (ERATE). Dig Liver Dis 2024; 56:1253-1256. [PMID: 38161088 DOI: 10.1016/j.dld.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/07/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
Enhanced recovery after surgery (ERAS) guidelines are evidence-based recommendations designed to improve patient outcomes and reduce complications after surgery. Although the ERAS guidelines focus primarily on surgical procedures, many of the principles could be applied also to therapeutic endoscopy as well. An extensive literature research on Embase and PubMed was thus made to reviewed articles regarding ERAS protocols applied to therapeutic endoscopy, organized by specific endoscopic field. Out of 214 papers, only 6 were relevant to the topic. Few studies explored in real life and in trial setting the hypothesized significance of ERAS principles applied to endoscopic procedures, mostly retrospective, not even covering the entire field of therapeutic endoscopy. This field of knowledge appears neglected so far by scientific community and endoscopic organizations. We believe that endoscopy units could benefit anyway from developing and implementing structured enhanced recovery pathways for their patients, therefore we subsequently created and suggested a simply and easily applicable, Enhanced Recovery protocol After Therapeutic Endoscopy which include preoperative preparation, anesthesia and sedation, nausea and vomiting (PONV) prophylaxis, and postoperative care.
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Affiliation(s)
- Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy; IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy
| | - Davide Massimi
- IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy.
| | - Chiara Ferrari
- IRCCS Humanitas Research Hospital, Department of Anestesiology, Rozzano, Italy
| | | | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy; IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy; IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy
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Meng W, Leung JW, Wang Z, Li Q, Zhang L, Zhang K, Wang X, Wang M, Wang Q, Shao Y, Zhang J, Yue P, Zhang L, Zhu K, Zhu X, Zhang H, Hou S, Cai K, Sun H, Xue P, Liu W, Wang H, Zhang L, Ding S, Yang Z, Zhang M, Weng H, Wu Q, Chen B, Jiang T, Wang Y, Zhang L, Wu K, Yang X, Wen Z, Liu C, Miao L, Wang Z, Li J, Yan X, Wang F, Zhang L, Bai M, Mi N, Zhang X, Zhou W, Yuan J, Suzuki A, Tanaka K, Liu J, Nur U, Weiderpass E, Li X. Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography: A single-blind, multicenter, randomized controlled trial. Chin Med J (Engl) 2024; 137:1437-1446. [PMID: 37620294 PMCID: PMC11188905 DOI: 10.1097/cm9.0000000000002820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients' recovery. METHODS This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. RESULTS The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t = 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26-0.71, P <0.001) and 0.76 (95% CI: 0.57-0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05-0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39-0.95, P = 0.028) in the multivariable models. CONCLUSION Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery. TRAIL REGISTRATION ClinicalTrials.gov , No. NCT03075280.
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Affiliation(s)
- Wenbo Meng
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Joseph W. Leung
- Division of Gastroenterology and Hepatology, UC Davis Medical Center, Sacramento, CA 95816, USA
| | - Zhenyu Wang
- Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin 300100, China
| | - Qiyong Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Hangzhou, Zhejiang 310000, China
| | - Leida Zhang
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Kai Zhang
- Hepatobiliary Surgery Department, Shandong Provincial Third Hospital, Jinan, Shandong 250000, China
| | - Xuefeng Wang
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Biliary Tract Disease Research, Shanghai 200000, China
| | - Meng Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130000, China
| | - Qi Wang
- Department of Hepatobiliary Surgery, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750000, China
| | - Yingmei Shao
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Center, Xinjiang Key Laboratory of Echinococcosis and Liver Surgery Research, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, China
| | - Jijun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030000, China
| | - Ping Yue
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Lei Zhang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Kexiang Zhu
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Xiaoliang Zhu
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Hui Zhang
- Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Senlin Hou
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Kailin Cai
- Gastrointestinal Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
| | - Hao Sun
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Ping Xue
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
| | - Wei Liu
- Division of Biliopancreatic Surgery, Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Haiping Wang
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Li Zhang
- Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin 300100, China
| | - Songming Ding
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Hangzhou, Zhejiang 310000, China
| | - Zhiqing Yang
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Ming Zhang
- Hepatobiliary Surgery Department, Shandong Provincial Third Hospital, Jinan, Shandong 250000, China
| | - Hao Weng
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Biliary Tract Disease Research, Shanghai 200000, China
| | - Qingyuan Wu
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130000, China
| | - Bendong Chen
- Department of Hepatobiliary Surgery, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750000, China
| | - Tiemin Jiang
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Center, Xinjiang Key Laboratory of Echinococcosis and Liver Surgery Research, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, China
| | - Yingkai Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030000, China
| | - Lichao Zhang
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Ke Wu
- Gastrointestinal Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
| | - Xue Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Zilong Wen
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
| | - Chun Liu
- Division of Biliopancreatic Surgery, Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Long Miao
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Zhengfeng Wang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Jiajia Li
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Xiaowen Yan
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Fangzhao Wang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Lingen Zhang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Mingzhen Bai
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Ningning Mi
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Xianzhuo Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Wence Zhou
- Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Jinqiu Yuan
- Clinical Research Centre, Scientific Research Centre, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518000 China
| | - Azumi Suzuki
- Department of Gastroenterology, Hamamatsu Medical Center, Hamamatsu 9800021, Japan
| | - Kiyohito Tanaka
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto 201101, Japan
| | - Jiankang Liu
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ula Nur
- Department of Public Health, College of Health Sciences, Qatar University, Doha 2713, Qatar
| | | | - Xun Li
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
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Rüggeberg A, Meybohm P, Nickel EA. Preoperative fasting and the risk of pulmonary aspiration-a narrative review of historical concepts, physiological effects, and new perspectives. BJA OPEN 2024; 10:100282. [PMID: 38741693 PMCID: PMC11089317 DOI: 10.1016/j.bjao.2024.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024]
Abstract
In the early days of anaesthesia, the fasting period for liquids was kept short. By the mid-20th century 'nil by mouth after midnight' had become routine as the principles of the management of 'full stomach' emergencies were extended to include elective healthy patients. Back then, no distinction was made between the withholding of liquids and solids. Towards the end of the last century, recommendations of professional anaesthesiology bodies began to reduce the fasting time of clear liquids to 2 h. This reduction in fasting time was based on the understanding that gastric emptying of clear liquids is rapid, exponential, and proportional to the current filling state of the stomach. Furthermore, there was no evidence of a link between drinking clear liquids and the risk of aspiration. Indeed, most instances of aspiration are caused by failure to identify aspiration risk factors and adjust the anaesthetic technique accordingly. In contrast, long periods of liquid withdrawal cause discomfort and may also lead to serious postoperative complications. Despite this, more than two decades after the introduction of the 2 h limit, patients still fast for a median of up to 12 h before anaesthesia, mainly because of organisational issues. Therefore, some hospitals have decided to allow patients to drink clear liquids within 2 h of induction of anaesthesia. Well-designed clinical trials should investigate whether these concepts are safe in patients scheduled for anaesthesia or procedural sedation, focusing on both aspiration risk and complications of prolonged fasting.
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Affiliation(s)
- Anne Rüggeberg
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Eike A. Nickel
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
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Tan SHS, Elshikhawoda MSM, Jararaa S, Cheung CP, Jararah H. Preoperative Snack Prescription: A Single-Centre Experience in Optimising Preoperative Fasting Time and Enhancing Guideline Adherence. Cureus 2023; 15:e46271. [PMID: 37908906 PMCID: PMC10615353 DOI: 10.7759/cureus.46271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
Objectives Preoperative fasting plays a pivotal role in adequately preparing patients for anaesthesia and surgical procedures. However, it is imperative to consider not only the medical aspects but also patients' overall comfort, as this can significantly contribute to improved surgical outcome. The primary objective of this quality improvement project (QIP) is to provide healthcare professionals, including anaesthetists, surgeons, nurses, and stakeholders with information regarding insights required to embrace the concept of preoperative snack prescription as a strategy for enhancing patient-centred care. Methods This QIP was conducted in the vascular surgery department of a district general hospital in Wales, United Kingdom. A prospective analysis was conducted in two cycles, i.e., the pre-intervention group (PrIG) and post-intervention group (PoIG), with preoperative snacks such as biscuits, chips, or cakes, being prescribed to the PoIG. A total of 40 patients who met the inclusion criteria were enrolled in this study, with 20 patients participating in each cycle. The timing of preoperative meals, i.e., the closest preoperative breakfast, lunch, or dinner, preoperative snacks (for the PoIG), anaesthesia commencement, and surgical commencement were collected. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), in conjunction with Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). Results In our QIP, the PrIG and PoIG comprised 40% (8 out of 20) and 35% (7 out of 20) female patients, respectively, with mean ages of 74 years (range, 61-86 years) and 61.3 years (range, 36-81 years). Within the PrIG, the mean duration from the preoperative meal to anaesthesia and surgery commencement was 17.8 hours (range, 14.6-22.5 hours) and 18.5 hours (range, 16.0-23.3 hours), respectively. In the PoIG, following the initiation of preoperative snack prescription, the mean time intervals between preoperative snack prescription and anaesthesia and surgery commencement were 10.9 hours (range, 6.5-16.0 hours) and 12.0 hours (range, 7.5-16.5 hours), respectively. Conclusions In summary, our QIP has successfully integrated preoperative snack prescription into the local hospital's preoperative care policy, prioritising the balance between patient safety and comfort. Based on our single-centre experience, we observed a significant reduction in the time interval between preoperative fasting and the initiation of anaesthesia, decreasing from 18.3 hours to 10.9 hours post-implementation of preoperative snacks. This QIP holds relevance for healthcare professionals as it underscores the benefits of shorter fasting periods, which contribute to heightened patient satisfaction and comfort.
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Affiliation(s)
- Steven H S Tan
- Trauma and Orthopaedics, University Hospital Llandough, Penarth, GBR
- Vascular Surgery, Glan Clwyd Hospital, Rhyl, GBR
| | | | | | - Che-Pin Cheung
- Trauma and Orthopaedics, Bronglais Hospital, Aberystwyth, GBR
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Joshi GP, Abdelmalak BB, Weigel WA, Harbell MW, Kuo CI, Soriano SG, Stricker PA, Tipton T, Grant MD, Marbella AM, Agarkar M, Blanck JF, Domino KB. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting. Anesthesiology 2023; 138:132-151. [PMID: 36629465 DOI: 10.1097/aln.0000000000004381] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
These practice guidelines are a modular update of the "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures." The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.
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Tong E, Chen Y, Ren Y, Zhou Y, Di C, Zhou Y, Shao S, Qiu S, Hong Y, Yang L, Tan X. Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials. Front Nutr 2022; 9:951676. [PMID: 36505254 PMCID: PMC9726728 DOI: 10.3389/fnut.2022.951676] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Preoperative carbohydrate loading is an important element of the enhanced recovery after surgery (ERAS) paradigm in adult patients undergoing elective surgery. However, preoperative carbohydrate loading remains controversial in terms of improvement in postoperative outcomes and safety. We conducted a Bayesian network meta-analysis to evaluate the effects and safety of different doses of preoperative carbohydrates administrated in adult patients after elective surgery. Methods MEDLINE (PubMed), Web of Science, EMBASE, EBSCO, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure (CNKI) were searched to identify eligible trials until 16 September 2022. Outcomes included postoperative insulin resistance, residual gastric volume (RGV) during the surgery, insulin sensitivity, fasting plasma glucose (FPG), fasting serum insulin (Fin) level, the serum levels of C-reactive protein (CRP), postoperative scores of pain, patients' satisfaction, thirst, hunger, anxiety, nausea and vomit, fatigue, and weakness within the first 24 h after surgery and the occurrences of postoperative infection. The effect sizes were estimated using posterior mean difference (continuous variables) or odds ratios (dichotomous variables) and 95 credible intervals (CrIs) with the change from baseline in a Bayesian network meta-analysis with random effect. Results Fifty-eight articles (N = 4936 patients) fulfilled the eligibility criteria and were included in the meta-analysis. Both preoperative oral low-dose carbohydrate loading (MD: -3.25, 95% CrI: -5.27 to -1.24) and oral high-dose carbohydrate loading (MD: -2.57, 95% CrI: -4.33 to -0.78) were associated with postoperative insulin resistance compared to placebo/water. When trials at high risk of bias were excluded, association with insulin resistance was found for oral low-dose carbohydrate loading compared with placebo/water (MD: -1.29, 95%CrI: -2.26 to -0.27) and overnight fasting (MD: -1.17, 95%CrI: -1.88 to -0.43). So, there was large uncertainty for all estimates vs. control groups. In terms of safety, oral low-dose carbohydrate administration was associated with the occurrences of postoperative infection compared with fasting by 0.42 (95%Crl: 0.20-0.81). In the other outcomes, there was no significant difference between the carbohydrate and control groups. Conclusion Although preoperative carbohydrate loading was associated with postoperative insulin resistance and the occurrences of postoperative infection, there is no evidence that preoperative carbohydrate administration alleviates patients' discomfort. Systematic review registration [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022312944].
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Affiliation(s)
- Enyu Tong
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yiming Chen
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yanli Ren
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yuanyuan Zhou
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Chunhong Di
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, China
| | - Ying Zhou
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Shihan Shao
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Shuting Qiu
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yu Hong
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Lei Yang
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xiaohua Tan
- School of Public Health, Hangzhou Normal University, Hangzhou, China
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He Y, Tang X, Ning N, Chen J, Li P, Kang P. Effects of Preoperative Oral Electrolyte-Carbohydrate Nutrition Supplement on Postoperative Outcomes in Elderly Patients Receiving Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. Orthop Surg 2022; 14:2535-2544. [PMID: 36040184 PMCID: PMC9531096 DOI: 10.1111/os.13424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/12/2022] [Accepted: 07/02/2022] [Indexed: 12/28/2022] Open
Abstract
Objective Patients undergoing total knee arthroplasty (TKA) were primarily geriatric, with high risk of postoperative electrolyte disorders and malnutrition. Randomized controlled trials regarding oral nutrition supplement (ONS) strategies in TKA was sparse. This study aimed to evaluate the efficacy of preoperative oral electrolyte‐carbohydrate nutrition supplement (OECNS) on patients (aged >65 years) undergoing TKA. Methods From April 2019 to January 2020, 94 patients undergoing primary elective unilateral TKA in our hospital were considered in this prospective randomized controlled study. This study included patients aged over 65 years with ASA I‐III, and excluded patients with electrolyte disorders, malnutrition, and comorbidities. The control group (control group) received meal nutrition supplements (preoperative 6 h [Pre 6h]) and water (Pre 2h), while OECNS group (intervention group) received meal nutrition supplements (Pre 6h) and OECNS (Pre 2). The Student's t test and χ2 test was used. The primary outcomes were the patient‐reported comfort indicators (PRCIs) including hunger, thirst, nausea, vomiting, weakness, pain, anxiety, and general comfort. The secondary outcomes included indicators of electrolyte, nutrition, functional scores, clinical results, and complications. Results The scores of preoperative hunger (0.43 ± 0.10), pain (2.30 ± 0.34), and anxiety (9.04 ± 2.71) were significantly lower in OECNS group compared with control group (hunger, 1.19 ± 0.21; pain, 3.79 ± 0.26; anxiety, 11.21 ± 3.02) (Pre 1h) (all p < 0.05) as well as the weakness score on the first postoperative day (POD1) (OECNS group 3.57 ± 0.24; control group 5.15 ± 0.29; p < 0.001). A higher level of Na + (OECNS group 140.54 ± 3.39; control group 138.07 ± 5.21; p = 0.008) and a reduced rate of hyponatremia (OECNS group 6.4%; control group 21.3%; p = 0.036) on POD1 were found. Moreover, the higher level of blood glucose (Post 2h) and reduced rates of abnormal blood glucose (Pre 2h, Post 6h) were verified in control group (all p < 0.05). There was no significant difference regarding the other outcomes. Conclusion The administration of OECNS significantly improved subjective comfort, electrolytes, and blood glucose without increasing the rates of complications in patients (aged over 65 years) undergoing TKA.
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Affiliation(s)
- Yue He
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiumei Tang
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Ning
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Jiali Chen
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Peifang Li
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Pengde Kang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Oliveira CBD, Garcia AKA, Nascimento LAD, Conchon MF, Furuya RK, Rodrigues R, Fonseca LF. Effects of carbohydrate use on preoperative thirst: a randomized clinical trial. Rev Bras Enferm 2022; 75:e20210355. [PMID: 35894410 DOI: 10.1590/0034-7167-2021-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/31/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to evaluate the effectiveness of carbohydrate popsicles, carbohydrate solution, and usual care (fasting) on the intensity and discomfort of preoperative thirst. METHODS a randomized clinical trial with 60 preoperative patients aged between 18 and 60 years, randomized into three groups: control (fasting), carbohydrate solution (100 ml), and carbohydrate popsicle (100 ml). The outcomes were thirst intensity and discomfort. RESULTS there was a difference between groups for final thirst intensity (p = 0.01) and final thirst discomfort (p = 0.001). The effect size for both the Solution Group and the Popsicle Group was robust: 0.99 and 1.14, respectively. CONCLUSIONS the groups that received the carbohydrate fasting abbreviation showed a reduction in thirst discomfort compared to the control group. The carbohydrate popsicle proved more effective in reducing the intensity of thirst. NCT: 3.209.283.
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Oliveira CBD, Garcia AKA, Nascimento LAD, Conchon MF, Furuya RK, Rodrigues R, Fonseca LF. Efeitos da utilização do carboidrato sobre a sede no pré-operatório: ensaio clínico randomizado. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0355pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivos: avaliar a efetividade do picolé de carboidrato, solução de carboidrato e cuidado usual (jejum) sobre a intensidade e desconforto da sede no pré-operatório. Métodos: ensaio clínico randomizado, com 60 pacientes no pré-operatório, idade entre 18 e 60 anos, aleatorizados em três grupos: controle (jejum); solução de carboidrato (100 ml); picolé de carboidrato (100 ml). Os desfechos foram a intensidade e o desconforto da sede. Resultados: houve diferença entre os grupos quanto à intensidade final da sede (p = 0,01) e ao desconforto final da sede (p = 0,001). O tamanho do efeito tanto para o Grupo Solução quanto para o Grupo Picolé foi forte: 0,99 e 1,14, respectivamente. Conclusões: os grupos que receberam a abreviação do jejum com carboidrato apresentaram redução no desconforto da sede quando comparados ao grupo-controle. O picolé de carboidrato mostrou-se mais efetivo na redução da intensidade da sede. NCT: 3.209.283
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Liang Y, Yan X, Liao Y. The effect of shortening the preoperative fasting period on patient comfort and gastrointestinal function after elective laparoscopic surgery. Am J Transl Res 2021; 13:13067-13075. [PMID: 34956525 PMCID: PMC8661208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/02/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the influence of shortening preoperative fasting on the comfort and gastrointestinal function of patients undergoing elective laparoscopic surgery. METHODS a total of 179 patients undergoing elective laparoscopic cholecystectomies (LC) in our hospital from March, 2019 to August, 2020 were recruited as the study cohort and placed into the research group (n=97) or the control group (n=82) according to different fasting periods assigned to each patient. In the control group, the patients were subjected to 12-h fasting and 6-h water deprivation before their surgeries, and the patients in the research group were subjected to 6-h fasting and 2-h water deprivation. The preoperative hunger and thirst, comfort, anxiety, and intraoperative aspiration, as well as the postoperative hospital stay durations, the blood glucose levels, the nausea and vomiting, the pain levels, and the times to the recovery of gastrointestinal function were compared between the two groups. RESULTS The research group had shorter hospital stay durations and decreased blood glucose levels. No intraoperative aspiration occurred in either group, and the incidence of postoperative nausea and vomiting in the research group was lower than it was in control group. The patients in the research group were less hungry and thirsty and were more comfortable in the preoperative period, and their preoperative self-rating anxiety scale (SAS) and postoperative visual analog scale (VAS) scores were lower than the corresponding scores in the control group. The times to first oral feeding, ambulation, anal flatus, defecation, and bowel sounds in the research group were earlier than they were in the control group. CONCLUSION Shortening preoperative fasting improves the comfort levels of patients undergoing elective LC, alleviates thirst and hunger, promotes the recovery of gastrointestinal function, and relieves preoperative anxiety, postoperative pain, and adverse reactions.
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Affiliation(s)
- Yin Liang
- Operating Room, People's Hospital of Changshou District Chongqing 401220, China
| | - Xiaoqin Yan
- Operating Room, People's Hospital of Changshou District Chongqing 401220, China
| | - Yan Liao
- Operating Room, People's Hospital of Changshou District Chongqing 401220, China
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11
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Zhu L, Zhu L, Yu W. Analysis of pathological characteristics and nursing intervention of patients with gastric polyps based on image stitching algorithm and endoscopy. Pak J Med Sci 2021; 37:1620-1624. [PMID: 34712294 PMCID: PMC8520379 DOI: 10.12669/pjms.37.6-wit.4854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/08/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The paper uses image stitching algorithm to understand the clinical and pathological characteristics of gastric polyps under gastroscope, and provides objective basis for the clinical diagnosis and treatment of gastric polyps and nursing intervention. Methods: The endoscopic, pathological data and surgical conditions of 111 patients with gastric polyps detected in the hospital from January 2017 to August 2019 were retrospectively analyzed. Results: The elderly patients (≥60 years old) in this group were those with high incidence of gastric polyps (56.8%); 80 patients with single polyps (72.1%), 31 patients with multiple polyps (27.9%); polyps were mainly located in the stomach (53.2%); polyps diameter ≤0.5cm are more common (69.4%); polyps are mainly hyperplastic polyps (40.5%) and inflammatory polyps in 37 cases (33.3%). Polyps were removed by biopsy forceps in 30 cases, endoscopic submucosal injection of 0.9% NaCl solution combined with high-frequency electrosurgical removal of 54 cases, endoscopic mucosal resection (EMR) in 6 cases, and endoscopic submucosal dissection (ESD) in treatment of the 4 cases, the remaining 17 cases were treated with surgery, and 12 patients were followed up, 2 of whom relapsed. Conclusion: Gastric polyps are small in diameter and mostly single; polyps are mainly located in the stomach body, mainly hyperplastic polyps; treatment methods are mostly endoscopic resection, and there is a possibility of recurrence after polypectomy, and follow-up should be strengthened. Full preparation before the operation, close cooperation during the operation, and careful postoperative care are important links to ensure the safety of the operation and reduce complications such as upper gastrointestinal bleeding.
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Affiliation(s)
- Linzhen Zhu
- Linzhen Zhu, Deputy Director of the nurse. Endoscopy Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu City, 322000, Zhejiang Province, China
| | - Linlin Zhu
- Linlin Zhu, Deputy Director of the nurse. Beiyuan Street Community Health Service Centre, Yiwu City, 322000, Zhejiang Province, China
| | - Weihua Yu
- Weihua Yu, Attending Physician. Department of Digestive Medicine, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu City, 322000, Zhejiang Province, China
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12
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Jeong JY, Ahn JH, Shim JG, Lee SH, Ryu KH, Lee SH, Cho EA. Gastric emptying of preoperative carbohydrate in elderly assessed using gastric ultrasonography: A randomized controlled study. Medicine (Baltimore) 2021; 100:e27242. [PMID: 34664868 PMCID: PMC8448003 DOI: 10.1097/md.0000000000027242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Preoperative carbohydrate loading enhances postoperative recovery and reduces patient discomfort. However, gastric emptying of liquids can be delayed in elderly populations. Therefore, this study aimed to evaluate the gastric emptying of 400 mL of a carbohydrate drink ingested 2 hours before surgery in elderly patients. METHODS In this prospective, randomized controlled study, patients aged >65 years were allocated to either fast from midnight (nil per os [NPO] group, n = 29) or drink 400 mL of a carbohydrate drink 2 hours before surgery (carbohydrate group, n = 29). The gastric antrum was assessed using ultrasonography in the supine position, followed by the right lateral decubitus (RLD) position. The gastric antrum was graded as grade 0 (fluid not seen in both positions), grade 1 (fluid only seen in the RLD position), and grade 2 (fluid seen in both positions). The gastric antral cross-sectional area (CSA) and aspirated residual gastric volume were measured. RESULTS In 58 patients, the incidence of grade 2 stomach was 13.8% in NPO group and 17.2% in carbohydrate group (P = .790). The gastric antral CSA in the supine position was larger in carbohydrate group than in NPO group (4.42 [3.72-5.18] cm2 vs 5.31 [4.35-6.92] cm2, P = .018). The gastric antral CSA in the RLD position was not different in NPO and carbohydrate groups (P = .120). There was no difference in gastric volume (2 [0-7.5] vs 3 [0-13.4], P = .331) in NPO group versus carbohydrate group. CONCLUSION The incidence of grade 2 stomach was not different between NPO group and carbohydrate group in elderly patients.
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Affiliation(s)
- Jae Yong Jeong
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Hee Ahn
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Geum Shim
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Hyun Lee
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Ho Ryu
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ho Lee
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Ah Cho
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Cheng PL, Loh EW, Chen JT, Tam KW. Effects of preoperative oral carbohydrate on postoperative discomfort in patients undergoing elective surgery: a meta-analysis of randomized controlled trials. Langenbecks Arch Surg 2021; 406:993-1005. [PMID: 33629128 DOI: 10.1007/s00423-021-02110-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/01/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Fasting is a standard preoperative procedure performed to prevent vomiting and pulmonary aspiration during anaesthesia and surgery. However, fasting can cause postoperative physical and psychological discomfort. Intake of oral carbohydrate (CHO) may mimic the intake of food, which prevents postoperative discomfort. We conducted a meta-analysis to evaluate the effect and safety of preoperative oral CHO in adult surgical patients. METHODS Randomized controlled trials (RCTs) were searched for in the PubMed, EMBASE, and Cochrane Library databases. A meta-analysis was performed to calculate a pooled effect size by using random-effects models. The satisfaction outcomes were mouth dryness, hunger, thirst, pain severity, duration of hospitalization, homeostatic model assessment for insulin resistance (HOMA-IR), and the incidence of postoperative nausea and vomiting. The safety outcomes were the incidence of aspiration and infection. RESULTS In total, 57 RCTs involving 5606 patients were included. The outcomes of mouth dryness, thirst, hunger, and pain were assessed by a 10-point visual analogue scale (0 = best, 10 = worst). The severity of mouth dryness (weighted mean difference [WMD]: -1.26, 95% CI: -2.36 to -0.15), thirst (WMD: -1.36, 95% CI: -2.05 to -0.67), hunger (WMD: -1.66, 95% CI: -2.53 to -0.80), pain (WMD: -0.68, 95% CI: -1.01 to -0.35), duration of hospitalization (WMD: -0.39 day, 95% CI: -0.66 to -0.12), and HOMA-IR (WMD: -1.80, 95% CI: -2.84 to -0.76) were significantly lower in the CHO group than in the control group. The incidence of postoperative nausea and vomiting did not differ between the CHO and control groups. No aspiration was recorded in any of the groups. CONCLUSIONS Preoperative CHO can alleviate patient's discomfort without safety concerns. Surgeons and anaesthesiologists should strongly promote preoperative CHO as a strategy to enhance recovery after surgery protocols.
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Affiliation(s)
- Po-Lung Cheng
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - El-Wui Loh
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.,Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jui-Tai Chen
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. .,Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. .,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
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Cho EA, Huh J, Lee SH, Ryu KH, Shim JG, Cha YB, Kim MS, Song T. Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study. Anesth Analg 2021; 133:690-697. [PMID: 33591115 DOI: 10.1213/ane.0000000000005411] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group. METHODS Sixty-four patients scheduled for elective laparoscopic benign gynecologic surgery were enrolled and randomly assigned to the NPO group (n = 32) or the NO-NPO group (n = 32). After having a regular meal until midnight before surgery, the NPO group fasted until surgery, while the NO-NPO group ingested 400 mL of a carbohydrate drink at midnight and freely up to 2 hours before anesthesia. The primary outcome was the gastric antral CSA by gastric ultrasound in right lateral decubitus position (RLDP). Noninferiority was defined as a mean difference of CSA <2.8 cm2. Secondary outcomes included CSA in supine position, gastric volume (GV), GV per weight (GV/kg), GV/kg >1.5 mL/kg, and Perlas grade. RESULTS CSA in RLDP was not different between the NPO group (6.25 ± 3.79 cm2) and the NO-NPO group (6.21 ± 2.48 cm2; P = .959). The mean difference of CSA in RLDP (NO-NPO group - NPO group) was 0.04 (95% confidence interval [CI], -1.56 to 1.64), which was within the noninferiority margin of 2.8 cm2. CSA was not different between the 2 groups (4.17 ± 2.34 cm2 in NPO group versus 4.28 ± 1.23 cm2 in NO-NPO group; P = .828). GV in NPO group (70 ± 56 mL) was not different from NO-NPO group (66 ± 36 mL; mean difference, 3.66; 95% CI, -20 to 27; P = .756). GV/kg in the NPO group (1.25 ± 1.00 mL/kg) was not different from the NO-NPO group (1.17 ± 0.67 mL/kg; P = .694). The incidence of GV/kg > 1.5 mL/kg was not different between NPO (31.3%) and NO-NPO group (21.9%; P = .768). The median (interquartile range) of the Perlas grade was 1 (0-1) in NPO group and 0.5 (0-1) in NO-NPO group (P = .871). CONCLUSIONS Preoperative carbohydrates ingested up to 2 hours before anesthesia do not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound.
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Affiliation(s)
- Eun-Ah Cho
- From the Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Republic of Korea.,Department of Anesthesiology and Pain Medicine
| | - Jin Huh
- From the Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Republic of Korea
| | | | | | | | | | | | - Taejong Song
- Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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15
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Liu N, Jin Y, Wang X, Xiang Z, Zhang L, Feng S. Safety and feasibility of oral carbohydrate consumption before cesarean delivery on patients with gestational diabetes mellitus: A parallel, randomized controlled trial. J Obstet Gynaecol Res 2021; 47:1272-1280. [PMID: 33403738 DOI: 10.1111/jog.14653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/04/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022]
Abstract
AIM To investigate the safety and feasibility of taking low-concentration carbohydrate solution at 2 h before induction of anesthesia for gestational diabetes mellitus (GDM) patients. METHODS GDM patients undergoing cesarean section were randomly assigned to experimental group (n = 43) and control group (n = 42). Two hours before induction of anesthesia, participants in experimental group orally received 300 mL low-concentration carbohydrate solution, while those in control group received equivalent warm water. Blood glucose and serum insulin were measured at 2 h before induction of anesthesia, right before induction of anesthesia, and the morning of postoperative day 1. Neonatal blood glucose level was monitored at birth. Maternal gastrointestinal function and well-being were assessed perioperatively. RESULTS The levels of blood glucose and serum insulin right before induction of anesthesia in the experimental group were significantly higher than those in the control group. There were four cases with hypoglycemia in the experimental group and 19 cases in the control group right before induction of anesthesia (9.3% vs 45.2%, p < 0.001). The incidence of neonatal hypoglycemia was 2.3% in the experimental group and 7.1% in the control group with no significance. Hunger score of the participants between the two groups right before induction of anesthesia was significantly different. No aspiration, nausea, and vomiting occurred in both groups before, during, and after surgery. No significant difference was found in the time to the first flatus and abdominal distension between the two groups. CONCLUSION Taking low-concentration carbohydrate solution is safe and feasible for patients with GDM undergoing elective cesarean section.
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Affiliation(s)
- Ningning Liu
- Obstetrics Department, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Jin
- Obstetrics Department, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - XiaoJuan Wang
- Medicine Department, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenzhen Xiang
- Obstetrics Department, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Le Zhang
- Obstetrics Department, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Suwen Feng
- Nursing Department, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Zhang Z, Wang RK, Duan B, Cheng ZG, Wang E, Guo QL, Luo H. Effects of a Preoperative Carbohydrate-Rich Drink Before Ambulatory Surgery: A Randomized Controlled, Double-Blinded Study. Med Sci Monit 2020; 26:e922837. [PMID: 32856619 PMCID: PMC7477936 DOI: 10.12659/msm.922837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The guidelines recommend oral carbohydrates up to 2 hr before elective surgery. The objective of this study was to explore the safety and feasibility of preoperative carbohydrate drink in patients undergoing ambulatory surgery. Material/Methods Patients undergoing ambulatory surgery under general anesthesia were enrolled. They were fasted from midnight and randomly assigned to a study group (200 mL of a carbohydrate beverage) or the control group (pure water) and received the assigned drink 2 hr before surgery. Bedside ultrasonography was performed to monitor gastric emptying at T0 (before liquid intake), T1 (5 min after intake), T2 (1 hr after intake), and T3 (2 hr after intake). Subjective feelings of thirst, hunger, anxiety, and fatigue were assessed 1 hr after liquid intake using the visual analogue scale (VAS). Results In both groups, gastric antrum cross-sectional area, gastric content volume, and weight-corrected gastric content volume increased at T1 and returned to baseline at T3. These parameters were significantly higher in the study group at T2 (6.28±1.38 vs. 4.98±0.78, 67.22±29.49 vs. 49.04±15.4, 1.10±0.51 vs. 0.85±0.37, P<0.05). Thirst and hunger VAS scores were reduced in both groups. The study group suffered significantly less hunger (28.44±10.41 vs. 36.03±14.42, P<0.05). Blood electrolytes (sodium, potassium, calcium) and glucose concentration levels were similar in both groups at T2. No gastric regurgitation or pulmonary aspiration was recorded. Conclusions Administration of 200 mL of oral carbohydrate beverage 2 hr before ambulatory surgery is safe, effective, and can be used for preoperative management of fasting patients.
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Affiliation(s)
- Zhong Zhang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, Hunan, China (mainland)
| | - Rui-Ke Wang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, Hunan, China (mainland)
| | - Bin Duan
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, Hunan, China (mainland)
| | - Zhi-Gang Cheng
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, Hunan, China (mainland)
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, Hunan, China (mainland)
| | - Qu-Lian Guo
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, Hunan, China (mainland)
| | - Hui Luo
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, Hunan, China (mainland)
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