Ingestão de glutamina e maltodextrina duas horas no pré-operatório imediato melhora a sensibilidade à insulina pós-operatória: estudo aleatório, duplo-cego e controlado

Dock-Nascimento, Diana Borges; Aguilar-Nascimento, José Eduardo de; Waitzberg, Dan Linetzky

doi:10.1590/s0100-69912012000600002

Cited by 16 publications

(19 citation statements)

References 35 publications

(61 reference statements)

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“…The decrease in insulin resistance after the use of carbohydrate solutions is possibly due to the ability of glucose to modulate the catabolic and inflammatory response inherent to surgical trauma, improving insulin sensitivity 12 , 13 , 29 .…”

Section: Resultsmentioning

confidence: 99%

Pre-Operative Fasting: Why Abbreviate?

Campos

Neto

Guedes

et al. 2018

ABCD, arq. bras. cir. dig.

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Introduction : Considering the practice of preoperative fasting based on observations on the gastric emptying delay after induction and the time of this fast is closely linked to organic response to trauma, arise the question about preoperative fasting period necessary to minimize such response and support the professional with clinical and scientific evidence. Aim : To review the aspects related to the abbreviation of preoperative fasting from the metabolic point of view, physiology of gastric emptying, its clinical benefits and the currently recommendations. Method : Literature review was based on articles and guidelines published in English and Portuguese, without restriction of time until January 2017, in PubMed, SciELO and Cochrane with the descriptors: surgery, preoperative fasting, carbohydrate. From the universe consulted, 31 articles were selected. Results : The literature suggests that the abbreviation of fasting with beverage added carbohydrates until 2 h before surgery, can bring benefits on glycemic and functional parameters, reduces hospitalization, and does not present aspiration risk of healthy patients undergoing elective surgery. Another nutrient that has been added to the carbohydrate solution and has shown promising results is glutamine. Conclusion : The abbreviation of preoperative fasting with enriched beverage with carbohydrates or carbohydrate and glutamine seems to be effective in the care of the surgical patient, optimizing the recovery from of postoperative period.

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Section: Resultsmentioning

confidence: 99%

Pre-Operative Fasting: Why Abbreviate?

Campos

Neto

Guedes

et al. 2018

ABCD, arq. bras. cir. dig.

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“…A study involving gastrointestinal surgery showed that oral carbohydrates taken 2 hours before surgery significantly reduced the postoperative inflammatory response and CRP/albumin ratio and shortened the hospital stay. 16 Volume intake was a source of heterogeneity. There were no significant differences between the 200-ml carbohydrate intake group and the control group, while the gastric volume was reduced in the 400-ml intake group.…”

Section: Discussionmentioning

confidence: 99%

Shortened preoperative fasting for prevention of complications associated with laparoscopic cholecystectomy: a meta-analysis

Zhu

et al. 2017

J Int Med Res

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ObjectiveRoutine fasting (12 h) is always applied before laparoscopic cholecystectomy, but prolonged preoperative fasting causes thirst, hunger, and irritability as well as dehydration, low blood glucose, insulin resistance and other adverse reactions. We assessed the safety and efficacy of a shortened preoperative fasting period in patients undergoing laparoscopic cholecystectomy.MethodsWe searched PubMed, Embase and Cochrane Central Register of Controlled Trials up to 20 November 2015 and selected controlled trials with a shortened fasting time before laparoscopic cholecystectomy. We assessed the results by performing a meta-analysis using a variety of outcome measures and investigated the heterogeneity by subgroup analysis.ResultsEleven trials were included. Forest plots showed that a shortened fasting time reduced the operative risk and patient discomfort. A shortened fasting time also reduced postoperative nausea and vomiting as well as operative vomiting. With respect to glucose metabolism, a shortened fasting time significantly reduced abnormalities in the ratio of insulin sensitivity. The C-reactive protein concentration was also reduced by a shortened fasting time.ConclusionsA shortened preoperative fasting time increases patients’ postoperative comfort, improves insulin resistance, and reduces stress responses. This evidence supports the clinical application of a shortened fasting time before laparoscopic cholecystectomy.

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“…31 In addition, randomized clinical trials have shown that glutamine administration improves insulin sensitivity and protein metabolism in critically ill and in trauma patients. 32 – 34 Finally, glutamine supplementation, when combined with post-intensive care unit (ICU) physiotherapy and adequate protein delivery, has recently been shown to improve 6-min walk test times vs. physiotherapy alone. 29 These findings suggest that glutamine may help to preserve muscle mass and long-term physical function in burn patients.…”

Section: Background Rationale and Systematic Review Of The Literaturementioning

confidence: 99%

“…Historically, burn patients have significant glutamine deficiency early in their stay due to massive glutamine loss via the burn wound and severe catabolism. 14 , 32 In the context of our RE-ENERGIZE pilot study, we drew blood on 18 randomly selected patients to measure baseline plasma glutamine levels. The average level was below the lower range of normal at 408 ± 146 umol/L (normal values 420–700 µmol/L), indicating severe glutamine deficiency in our pilot burn patients, which was quite different from the REDOXS trial where very little baseline deficiency was observed.…”

Section: Background Rationale and Systematic Review Of The Literaturementioning

confidence: 99%

A RandomizEd trial of ENtERal Glutamine to minimIZE thermal injury (The RE-ENERGIZE Trial): a clinical trial protocol

Heyland

Wischmeyer

Jeschke

et al. 2017

Scars, Burns & Healing

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Background:Burn injury represents a significant public health problem worldwide. More than in any other injury, the inflammation and catabolism associated with severe burns can exacerbate nutrient deficiencies resulting in impaired immune function and increased risk of developing infection, organ dysfunction and death. Consequently, over the last few decades numerous trials have evaluated the impact of different nutritional strategies in severe burn injury. Glutamine is of particular interest, as it appears vital for a number of key stress-response pathways in serious illness. The purpose of the current manuscript is to provide the rationale and protocol for a large clinical trial of supplemental enteral glutamine in 2700 severe burn-injured patients.Methods:We propose a multicentre, double-blind, pragmatic, randomized, clinical trial involving 80 tertiary intensive care unit (ICU) burn centres worldwide. We aim to enrol patients with deep second- and/or third-degree burns at moderate or high risk for death. We will exclude patients admitted > 72 h before screening and patients with advanced liver and kidney disease. The study intervention consists of enteral glutamine 0.5 g/kg/day vs. isocaloric maltodextran control delivered enterally. Primary outcome will be six-month mortality. Key secondary outcomes include time to discharge alive from hospital, ICU and hospital mortality, length of stay and health-related quality of life at six months.Significance:This study will be the first large international multicentre trial examining the effects of glutamine in burn patients. Negative or positive, the results of this trial will inform the clinical practice of burns care worldwide.Clinicaltrials.gov ID #NCT00985205

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Ingestão de glutamina e maltodextrina duas horas no pré-operatório imediato melhora a sensibilidade à insulina pós-operatória: estudo aleatório, duplo-cego e controlado

Abstract: the abbreviation of preoperative fasting for two hours with dextrinomaltose and glutamine improves insulin sensitivity in patients undergoing elective laparoscopic cholecystectomy.

Cited by 16 publications

References 35 publications

Pre-Operative Fasting: Why Abbreviate?

Pre-Operative Fasting: Why Abbreviate?

Shortened preoperative fasting for prevention of complications associated with laparoscopic cholecystectomy: a meta-analysis

A RandomizEd trial of ENtERal Glutamine to minimIZE thermal injury (The RE-ENERGIZE Trial): a clinical trial protocol

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