Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics

Svanfeldt, Monika; Thorell, Anders; Hausel, Jonatan; Soop, Mattias; Rooyackers, Olav; Nygren, Jonas; Ljungqvist, Olle

doi:10.1002/bjs.5919

Cited by 189 publications

(122 citation statements)

References 35 publications

(51 reference statements)

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“…36 Furthermore, if patients are allowed to take solids up to 6 hours preoperatively and clear fluids up to 2 hours, there is no increase in complications, 36,37 which forms the basis of preoperative guidelines adopted by the Royal College of Anaesthetists 38 and the American Society of Anesthesiologists. 39 As mentioned previously, the use of carbohydrate loading attenuates postoperative insulin resistance, reduces nitrogen and protein losses, 40,41 preserves skeletal muscle mass and reduces preoperative thirst, hunger and anxiety. [42][43][44] It involves the use of clear carbohydrate drinks the day prior to surgery and up to 2 hours before.…”

Section: Carbohydrate Loading and Early Enteral Feedingmentioning

confidence: 94%

Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

Melnyk

Casey

Black

et al. 2013

CUAJ

249

114

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Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer. Despite improvements in surgical technique, anesthesia and perioperative care, radical cystectomy is still associated with greater morbidity and prolonged in-patient stay after surgery than other urological procedures. Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. The key elements of ERAS protocols include preoperative counselling, optimization of nutrition, standardized analgesic and anesthetic regimens and early mobilization. Despite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, they challenge traditional surgical doctrine, and as a result their implementation has been slow.The present article discusses particular aspects of ERAS protocols which represent fundamental shifts in surgical practice, including perioperative nutrition, management of postoperative ileus and the use of mechanical bowel preparation.

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Section: Carbohydrate Loading and Early Enteral Feedingmentioning

confidence: 94%

Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

Melnyk

Casey

Black

et al. 2013

CUAJ

249

114

View full text Add to dashboard Cite

show abstract

“…Carbohydrate loading is an important component of the ERAS protocol and is thought to be effective to avoid degradation of protein and enhance postoperative recovery [19,29]; however, it also has a potential drawback. Carbohydrate loading enhances intestinal movement [30], resulting in an adverse effect on the anastomotic site, particularly after upper gastrointestinal tract surgery.…”

Section: Discussionmentioning

confidence: 99%

A phase II study of an enhanced recovery after surgery protocol in gastric cancer surgery

et al. 2015

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Background The enhanced recovery after surgery (ERAS) protocol integrates a number of perioperative interventions and techniques, aiming at decreasing the morbidity rate and the length of postoperative hospital stay after surgery. Although it has become a standard perioperative management for colorectal surgery, the feasibility of the ERAS protocol for gastric surgery remains unclear. Methods This single-center, prospective phase II study included patients with gastric cancer undergoing curative gastrectomy. The primary end point was the incidence of Clavien-Dindo grade II or higher postoperative complications. The secondary end points were the incidence of anastomotic leakage, the incidence of pneumonia, the proportion of patients starting oral feeding at postoperative day 2, the completion rate of the ERAS protocol, the length of postoperative hospital stay, the readmission rate within 30 days after discharge, and the mortality rate. Results From September 2013 to September 2014, 121 eligible patients were enrolled in this study. The incidence of postoperative complications was 10.7 % (90 % confidence interval, 6.47-16.54 %). Anastomotic leakage and pneumonia was observed in one and zero patients, respectively. The median length of postoperative hospital stay was 8 days, and the completion rate of the ERAS protocol was 85.1 %. The readmission rate and the mortality rate were 0 %. Conclusions The ERAS protocol can be safely used in patients undergoing gastric cancer surgery. The superiority of the ERAS protocol over non-ERAS perioperative management should be clarified.

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“…Reduced protein breakdown has been shown with ingestion of large amounts of carbohydrate (175-200 g) prior to colorectal surgery when compared with a low carbohydrate dose (35-40 g) (13) .…”

Section: Carbohydrate Loadingmentioning

confidence: 99%

Pre-operative nutrition and carbohydrate loading

Kratzing

2011

Proc. Nutr. Soc.

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An optimal nutritional state is an important consideration in providing successful operative outcomes. Unfortunately, many aspects of surgery are not constructive to providing this. In addition, the metabolic and immune response to injury induces a catabolic state and insulin resistance, a known risk factor of post-operative complications. Aggressive insulin therapy post-operatively has been shown to reduce morbidity and mortality but similar results can be achieved when insulin resistance is lessened by the use of pre-operative carbohydrate loading. Consuming carbohydrate-containing drinks up to 2 h before surgery has been found to be an effective way to attenuate insulin resistance, minimise protein losses, reduce hospital stays and improve patient comfort without adversely affecting gastric emptying. Enhanced recovery programmes have employed carbohydrate loading as one of several strategies aimed at reducing post-operative stress and improving the recovery process. Studies examining the benefits of these programmes have demonstrated significantly shorter post-operative hospital stays, faster return to normal functions and lower occurrences of surgical complications. As a consequence of the favourable evidence they are now being implemented in many surgical units. Further benefit to post-operative recovery may be found with the use of immune-enhancing diets, i.e. supplementation with n-3 fatty acids, arginine, glutamine and/or nucleotides. These have the potential to boost the immune system, improve wound healing and reduce inflammatory markers. Research exploring the benefits of immunonutrition and solidifying the use of carbohydrate loading is ongoing; however, there is strong evidence to link good pre-operative nutrition and improved surgical outcomes.Pre-operative nutrition: Carbohydrate loading: Immunonutrition

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Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics

Abstract: Whole-body protein balance and the suppressive effect of insulin on endogenous glucose release are better maintained when patients receive a CHO-rich beverage before surgery.

Cited by 189 publications

References 35 publications

Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

A phase II study of an enhanced recovery after surgery protocol in gastric cancer surgery

Pre-operative nutrition and carbohydrate loading

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