Document Detail


The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery--a randomized controlled trial.
MedLine Citation:
PMID:  20177856     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIMS: Increasing evidence suggests that preoperative fasting, as was the clinical practice for many decades, might be associated with untoward consequences and that a standardized preoperative intake of nutrients might be advantageous; this is a component of the enhanced recovery after surgery (ERAS) concept. Thus, in a randomized controlled trial we compared preoperative fasting with preoperative preparation with either oral or intravenous intake of carbohydrates, minerals and water. Biochemical, psychosomatic, echocardiographic and muscle-power parameters were assessed in surgical patients with colorectal diseases during the short-term perioperative period. We also assessed the safety of peroral intake shortly before surgery. METHODS: A total of 221 elective colorectal surgery patients in this bicentric, randomized, prospective and blinded clinical trial were divided into three groups: A - patients fasting from midnight (control group); B - patients supported preoperatively by glucose, magnesium and potassium administered intravenously; C - patients supported preoperatively by oral consumption of a specifically composed solution (potion). RESULTS: The general perioperative clinical status of patients in groups C and B was significantly better than those in group A. Psychosomatic conditions postoperatively were found to be best in group C (P < 0.029). The rise in the index of insulin resistance (QUICKI) from the preoperative to the postoperative state was significant in group A (P < 0.05). The systolic and diastolic function of the left ventricle improved postoperatively in group C vs. group A (P < 0.04), and the ejection fraction was also significantly higher postoperatively in group C vs. group A (P < 0.03). The gastric residual volume was 5 ml and the pH of stomach juice was 3.5-5 in all groups without statistically significant difference. No difference was found in the length of hospital stay or the rate of complications. CONCLUSIONS: Preoperative fasting does not confer any benefit or advantage for surgical patients. In contrast, consumption of an appropriate potion composed of water, minerals and carbohydrates offers some protection against surgical trauma in terms of metabolic status, cardiac function and psychosomatic status. Peroral intake shortly before surgery did not increase gastric residual volume and was not associated with any risk.
Authors:
Milan Kaska; Tat'?na Grosmanov?; Eduard Havel; Radom?r Hyspler; Zbynka Petrov?; Miroslav Brtko; Pavel Bares; David Bares; Bronislava Schusterov?; Lucie Pyszkov?; Vlasta Tosnerov?; Martin Sluka
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Wiener klinische Wochenschrift     Volume:  122     ISSN:  1613-7671     ISO Abbreviation:  Wien. Klin. Wochenschr.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-23     Completed Date:  2010-05-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  21620870R     Medline TA:  Wien Klin Wochenschr     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  23-30     Citation Subset:  IM    
Affiliation:
Academic Department of Surgery, University Hospital and Faculty of Medicine Hradec Kr?lov?, Czech Republic. kaskam@lfhk.cuni.cz
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Colorectal Neoplasms / surgery*
Dietary Carbohydrates / administration & dosage*,  adverse effects
Digestive System Surgical Procedures / adverse effects*
Fasting*
Female
Humans
Injections, Intravenous / adverse effects,  methods
Male
Middle Aged
Postoperative Complications / prevention & control*
Preoperative Care / methods*
Recovery of Function*
Single-Blind Method
Treatment Outcome
Chemical
Reg. No./Substance:
0/Dietary Carbohydrates
Comments/Corrections
Comment In:
Wien Klin Wochenschr. 2010 Jan;122(1-2):6-7   [PMID:  20177852 ]

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