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CARDIOVASCULAR ANESTHESIA

Preoperative Oral Carbohydrate Administration to ASA III-IV Patients Undergoing Elective Cardiac Surgery

Jan-P. Breuer, MD^*, Vera von Dossow, MD^*, Christian von Heymann, MD^*, Markus Griesbach, MD^*, Michael von Schickfus, Cand med^*, Elise Mackh, Cand med^*, Cornelia Hacker, Cand med^*, Ulrike Elgeti, MD, Wolfgang Konertz, MD, Klaus-D. Wernecke, PhD, and Claudia D. Spies, MD^*

From the *Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum; Department of Cardiovascular Surgery; and Institute of Medical Statistics and Biometry, Campus Charité Mitte, CHARITÉ University Medicine Berlin, Berlin, Germany.

Address correspondence and reprint requests to Claudia Spies, MD, Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, CHARITÉ University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Address e-mail to claudia.spies{at}charite.de.

In this study we investigated the effects of preoperative oral carbohydrate administration on postoperative insulin resistance (PIR), gastric fluid volume, preoperative discomfort, and variables of organ dysfunction in ASA physical status III-IV patients undergoing elective cardiac surgery, including those with noninsulin-dependent Type-2 diabetes mellitus. Before surgery, 188 patients were randomized to receive a clear 12.5% carbohydrate drink (CHO), flavored water (placebo), or to fast overnight (control). CHO and placebo were treated in double-blind format and received 800 mL of the corresponding beverage in the evening and 400 mL 2 h before surgery. Patients were monitored from induction of general anesthesia until 24 h postoperatively. Exogenous insulin requirements to control blood glucose levels 10.0 mmol/L were used as a marker for PIR. Gastric fluid volume was measured by passive gastric reflux and preoperative discomfort using visual analog scales. Postoperative clinical and surgical data were recorded. Blood glucose levels and insulin requirements did not differ between groups. Patients receiving CHO and placebo were less thirsty compared with controls (P < 0.01 and P = 0.06, respectively). Ingested liquids did not cause increased gastric fluid volume or other adverse events. The CHO group required less intraoperative inotropic support after initiation of cardiopulmonary bypass weaning (P < 0.05). In conclusion, preoperative CHO administration before cardiac surgery does not affect PIR. Clear fluids reduce thirst and may be recommended as a safe procedure in ASA III-IV patients. Further research is indicated to investigate possible cardioprotective effects of preoperative CHO intake.

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