Fasting abbreviation among patients submitted to oncologic surgery: systematic review

Pinto, Andrea Troller; Grigoletti, Shana Souza; Marcadenti, Aline

doi:10.1590/s0102-67202015000100018

Cited by 17 publications

(12 citation statements)

References 24 publications

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“…Open colorectal surgery affects the homeostatic balance via extensive surgical stress. Preoperative CHO drink loading is a part of the enhanced recovery after surgery (ERAS) programme, which is applied in colorectal surgery to reduce stress response, PIR and hospital stay [17]. Applying new protocols is not always a simple process.…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing colorectal surgery

Rizvanović

Adam

Čaušević

et al. 2019

Int J Colorectal Dis

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Purpose This study aimed to evaluate the effect of preoperative carbohydrate oral (CHO) loading on the postoperative metabolic and inflammatory response, perioperative discomfort and surgical clinical outcomes in open colorectal surgery compared with a conventional fasting protocol. Methods Fifty patients were randomly allocated to either the intervention group (CHO), to receive preoperative oral carbohydrate supplementation, or the control group (FAST), to undergo preoperative fasting. Insulin resistance, insulin sensitivity, the Glasgow Prognostic Score (GPS) and IL-6 levels were analysed at 06 h on the day of surgery (T 1 ), 6 h after surgery (T 2 ) and at 06 h on postoperative day 1 (T 3 ) and postoperative day 2 (T 4 ). Thirst, hunger, dry mouth, weakness, anxiety and pain were assessed using the visual analogue scale (VAS) prior to anaesthesia induction and at 0-4, 4-8, 8-12 and 12-24 h after surgery. Surgical clinical outcomes included the return of gastrointestinal function, time to independent ambulation and postoperative discharge day. Results Postoperative insulin resistance was 30% lower (p < 0.03) and insulin sensitivity was 15% higher (p < 0.05) in the CHO group than in the FAST group. The GPS was lower in the CHO group at T 1 (p < 0.001), T 3 (p < 0.01) and T 4 (p < 0.004). IL-6 serum levels were lower at the analysed postoperative time points in the CHO group (p < 0.001). The VAS well-being score was lower in the intervention group (p < 0.001); however, the VAS pain score was not significantly different between the groups. The evaluated surgical outcomes appeared earlier in the CHO group (p < 0.001). Conclusion A preoperative CHO drink reduced the postoperative metabolic and inflammatory response and improved subjective well-being and surgical clinical outcomes but did not diminish the VAS pain score.

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Section: Discussionmentioning

confidence: 99%

A randomised controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing colorectal surgery

Rizvanović

Adam

Čaušević

et al. 2019

Int J Colorectal Dis

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“…In 2015, Pinto Ados et al. 7 published a meta-analysis of the impact of a shortened fasting time on perioperative complications in patients undergoing elective cancer surgery. The effects of preoperative carbohydrates on glycaemic parameters, inflammatory markers, indicators of malnutrition and the hospital stay were evaluated in patients who underwent surgery for colorectal cancer and gastric cancer.…”

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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“…Although security is well established in preoperative abbreviation of fasting time 13 , 18 , 24 , we observe high strength from conventional services in pediatric surgery to implement this approach 7 . Likewise, studies show that early refeeding after operation is safe and optimizes postoperative recovery 10 .…”

Section: Introductionmentioning

confidence: 95%

Changing Paradigms in Preoperative Fasting: Results of a Joint Effort in Pediatric Surgery

Carvalho

Carvalho²,

Nogueira

et al. 2017

ABCD, arq. bras. cir. dig.

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Background: Current researches associate long fasting periods to several adverse consequences. The fasting abbreviation to 2 h to clear liquids associated with the use of drinks containing carbohydrates attenuates endocrinometabolic response to surgical trauma, but often is observed children advised to not intake food from 00:00 h till the scheduled surgical time, regardless of what it is. Aim: To evaluate the safety of a protocol of preoperative fasting abbreviation with a beverage containing carbohydrates, and early postoperative feeding in children underwent elective small/mid-size surgical procedures during a national task-force on pediatric surgery. Methods: Thirty-six patients were prospectively included, and for several reasons five were excluded. All 31 who remained in the study received a nutritional supplement containing 150 ml of water plus 12.5% maltodextrin 2 h before the procedure. Data of the pre-operative fasting time, anesthetic complications and time of postoperative refeeding, were collected. Results:Twenty-three (74.2%) were males, the median age was 5 y, and the median weight was 20 kg. The median time of pre-operative fasting was 145 min and the time of post-operative refeeding was 135 min. There were no adverse effects on the anesthetic procedures or during surgery. Post-operatively, two children (6.5%) vomited. Conclusion: The abbreviation of pre-operative fasting to 2 h with beverage containing carbohydrate in pediatric surgery is safe. Early refeeding in elective small/mid-size procedures can be prescribed.

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Fasting abbreviation among patients submitted to oncologic surgery: systematic review

Cited by 17 publications

References 24 publications

A randomised controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing colorectal surgery

A randomised controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing colorectal surgery

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

Changing Paradigms in Preoperative Fasting: Results of a Joint Effort in Pediatric Surgery

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