Preoperative Oral Carbohydrate Administration Can Ameliorate Perioperative Stress and Metabolism for Patients with Surgical Thoracic Oncology_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Limin , KANG Xiaozheng , CHEN Jiheng , FAN Zhiyi , YANG Zhi , SHEN Luyan , CHEN Keneng.

1. Key Laboratory of Carcinogenesis and Translational Research， Ministry of Education， Department 1 of Thoracic Surgery， Cancer Hospital &;
Institute，Peking University， Beijing 100142， P. R. China;;
2. Department of Anesthesiology， Cancer Hospital &;
Institute， Peking University， Beijing 100142， P. R. China;;
3. Department of Nuclear Medicine， Cancer Hospital &;
Institute， Peking University， Beijing 100142， P. R. China;

Corresponding author：

Keywords：

Carbohydrate; 　Thoracic oncology; 　Surgery; 　Insulin resistance; 　Stress; 　Metabolism

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Abstract：　Objective　To investigate the effect of preoperative oral carbohydrate （CHO） administration on perioperative risks of patients with surgical thoracic oncology，and provide evidence for establishing new scientific preoperative fasting strategy.Methods?In this prospective study， from July to September 2010，32 out of 65 enrolled patients with surgical thoracic oncology in Department 1 of Thoracic Surgery，Cancer Hospital of Peking University， were randomly allocated to preoperative experiment group （fasting overnight and oral 12.5% dextrose 400 ml administration 2 h before anesthesia induction） or control group （fasting overnight and water deprivation from midnight）. Clinical data were collected including subjective evaluation of thirst and hunger measured by visual analogue scale （VAS）， blood glucose level（BGL），serum insulin level， homeostasis model assessment insulin resistance（HOMA-IR），postoperative length of hospital stay （LOS） and complications.Results?Sixteen patients were enrolled in each group. VAS scores of thirst and hunger of the preoperative experiment group at 1 h before anesthesia induction were significantly lower than those of the control group（24 vs. 49，24 vs. 62 ，P=0.000）. BGL（8.59±0.43 mmol/L vs. 5.59±0.43 mmol/L， P=0.000）， serum insulin level （24.33±1.80 mIU/ ml vs. 16.28±1.80 mIU/ml， P=0.004）and HOMA-IR（9.23±0.77 vs. 4.03±0.77，P=0.000）of the preoperative experiment group before anesthesia induction were significantly higher than those of the control group，and these three variables of the preoperative experiment group returned to baseline level soon after surgery. There was no statistical difference in postoperative LOS and complication rate between the two groups （P＞0.05）.Conclusion?Preoperative oral CHO treatment is safe for non-diabetic patients with surgical thoracic oncology， can alleviate their subjective discomfort，decrease insulin resistance， and ameliorate their perioperative stress and metabolism.

Citation： ZHANG Limin,KANG Xiaozheng,CHEN Jiheng,FAN Zhiyi,YANG Zhi,SHEN Luyan,CHEN Keneng.. Preoperative Oral Carbohydrate Administration Can Ameliorate Perioperative Stress and Metabolism for Patients with Surgical Thoracic Oncology. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 463-467. doi: Copy

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9.	Svanfeldt M， Thorell A， Hausel J， et al. Effect of "preoperative" oral carbohydrate treatment on insulin action--a randomised cross-over unblinded study in healthy subjects. Clin Nutr， 2005， 24 （5）：815-821.
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11.	Ljungqvist O， Soreide E. Preoperative fasting . Br J Surg， 2003， 90 （4）：400-406.

1. 　Snow J. On the Inhalation of the Vapour of Ether in Surgical Operations. London， England： John Churchill. 1847， 43-44.
2. 　Søreide E， Ljungqvist O. Modern preoperative fasting guidelines： a summary of the present recommendations and remaining questions. Best Pract Res Clin Anaesthesiol， 2006， 20 （3）：483-491.
3. 　Melis GC， van Leeuwen PA， von Blomberg-van der Flier BME， et al. A carbohydrate-rich beverage prior to surgery prevents surgery-induced immunodepression： a randomized， controlled， clinical trial. JPEN J Parenter Enteral Nutr， 2006， 30 （1）： 21-26.
4. 　Nygren J， Thorell A， Ljungqvist O. Preoperative oral carbohydrate nutrition：an update. Curr Opin Clin Nutr Metab Care， 2001， 4 （4）：255-259.
5. 　Hausel J， Nygren J， Lagerkranser M， et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg， 2001， 93 （5）：1344-1350.
6. 　Wallace TM， Levy JC， Matthews DR. Use and abuse of HOMA modeling . Diabetes Care， 2004， 27 （6）：1487-1495.
7. 　Mathur S， Plank LD， McCall JL， et al. Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Br J Surg ， 2010， 97 （4）： 485-494.
8. 　Nygren J， Soop M， Thorell A， et al. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nur， 1998 ， 17 （2）：65-71.
9. 　Svanfeldt M， Thorell A， Hausel J， et al. Effect of "preoperative" oral carbohydrate treatment on insulin action--a randomised cross-over unblinded study in healthy subjects. Clin Nutr， 2005， 24 （5）：815-821.
10. 　Helminena H， Viitanenb H， Sajantia J. Effect of preoperative intravenous carbohydrate loading on preoperative discomfort in elective surgery patients. Eur J Anaesth， 2009， 26 （2）：123-127.
11. 　Ljungqvist O， Soreide E. Preoperative fasting . Br J Surg， 2003， 90 （4）：400-406.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Preoperative Oral Carbohydrate Administration Can Ameliorate Perioperative Stress and Metabolism for Patients with Surgical Thoracic Oncology

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