Benefits of Fasting Abbreviation with Carbohydrates and Omega-3 Infusion During CABG: a Double-Blind Controlled Randomized Trial

Abstract

Objective To assess postoperative clinical data considering the association of preoperative fasting with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). Methods 57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control. Results There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P =0.023), needed fewer vasoactive drugs during surgery and ICU stay ( P <0.05); and had better blood glucose levels in the first six hours of recovery ( P =0.015), requiring less exogenous insulin ( P =0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups ( P =0.009). Subjects who receive ω-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P =0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively ( P =0.008). Interleukin-10 levels varied among groups ( P =0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ω-3 PUFA ( P =0.049). Conclusion Fasting abbreviation with carbohydrate loading and intraoperative infusion of ω-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG.

The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials

“…This yielded 9 studies that were included in the meta-analysis. However, in two trials [ 54 , 55 ], the same study cohort was reported with a percent of identical results, thus in present work, these results were not used in duplicate where applicable.…”

“…Altogether, nine studies ( N = 9) were included [ 45 , 47 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ] comprising 11 interventions. However, as mentioned previously, two studies comprised the same study group and presented similar results in separate papers, thus the numbers of studies and interventions are 8 and 10, respectively.…”

“…However, as mentioned previously, two studies comprised the same study group and presented similar results in separate papers, thus the numbers of studies and interventions are 8 and 10, respectively. These were double-blind [ 54 , 55 , 56 ] or open-label prospective trials [ 45 , 47 , 57 , 58 , 59 ]. In the majority of studies [ 45 , 47 , 54 , 55 , 56 , 57 , 58 ], 12.5% oral carbohydrate (OCH) solution was used.…”

“…The most frequent comparator in the studies included into the qualitative synthesis was fasting [ 45 , 47 , 57 , 58 , 59 , 60 ]. In three trials (including a duplicate study by Feguri et al 2017 and Feguri et al 2019), patients received water instead of OCH load [ 54 , 55 , 56 ].…”

“…These were predominantly men ( n = 469, 76.3%), aged between 57 and 68.5 years. In the majority of studies, coronary artery bypass grafting with cardio-pulmonary bypass and general anesthesia with endotracheal intubation was performed [ 45 , 47 , 54 , 55 , 56 , 57 , 58 ]. A subgroup of patients in a study by Sokolic et al [ 60 ] underwent off-pump coronary artery bypass grafting (OPCAB).…”