Evaluation of preoperative oral carbohydrate administration on insulin resistance in off-pump coronary artery bypass patients: A randomised trial.
Eur J Anaesthesiol
; 34(11): 740-747, 2017 11.
Article
em En
| MEDLINE
| ID: mdl-28437263
ABSTRACT
BACKGROUND:
In fasting cardiac surgery patients, preoperative carbohydrate (CHO) drink intake attenuated insulin resistance and improved cardiac metabolism, although its beneficial effects were not evident after cardiac surgery possibly due to cardiopulmonary bypass-related extreme systemic inflammation.OBJECTIVE:
We aimed to evaluate whether preoperative CHO intake affected insulin resistance and free-fatty acid (FFA) concentrations in off-pump coronary revascularisation.DESIGN:
A randomised controlled trial.SETTING:
Primary care in a university hospital in Korea from January 2015 to July 2016. PATIENTS Sixty patients who underwent elective multi-vessel off-pump coronary revascularisation were randomised into two groups. Three patients were excluded from analysis and 57 patients completed study. INTERVENTION The CHO group received oral CHO (400âml) the prior evening and 2 to 3âh before surgery, and the control group was fasted from food and water according to standard protocol. MAIN OUTCOMEMEASURES:
Insulin resistance was assessed twice, after anaesthetic induction and after surgery via short insulin tolerance test. FFA, C-reactive protein and creatine kinase-myocardial band concentrations were determined serially for 48âh after surgery.RESULTS:
Insulin sensitivity was greater (Pâ=â0.002) and plasma FFA concentrations were lower (Pâ=â0.001) after anaesthetic induction in the CHO group compared with the Control group, although there were no intergroup differences after surgery. The postoperative peak creatine kinase-myocardial band concentration was significantly lower in the CHO group compared with the Control group [8.8 (5.4 to 18.2) vs. 6.4 (3.5 to 9.7)ângâml, Pâ=â0.031].CONCLUSION:
A preoperative CHO supplement significantly reduced insulin resistance and FFA concentrations compared with fasting at the beginning of the surgery, but these benefits were lost after off-pump coronary revascularisation. Despite their transient nature, these beneficial effects resulted in less myocardial injury, mandating further studies focused on the impact of preoperative CHO on myocardial ischaemia and cardiac function after coronary revascularisation. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT 02330263.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
/
Cuidados Pré-Operatórios
/
Resistência à Insulina
/
Carboidratos da Dieta
/
Ponte de Artéria Coronária sem Circulação Extracorpórea
Tipo de estudo:
Clinical_trials
/
Guideline
/
Observational_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article