Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration.
BACKGROUND
Overnight fasting is routine before elective surgery. This may not be the optimal way to prepare for surgical stress, however, because intravenous carbohydrate supplementation instead of fasting has recently been shown to reduce postoperative insulin resistance. In the current study, gastric emptying of a carbohydrate-rich drink was investigated before elective surgery and in a control situation.


METHODS
Twelve patients scheduled for elective surgery were randomly given 400 mL of either a carbohydrate-rich drink (285 mOsm/kg, 12.0% carbohydrates, n = 6) or water 4 hours before being anesthetized. Gastric emptying was measured (gamma camera, 99Tcm). Each patient repeated the protocol postoperatively as a control. All values were presented as the mean +/- SEM by means of a nonparametric statistical evaluation.


RESULTS
Despite the increased anxiety experienced by patients before surgery (p < 0.005), gastric emptying did not differ between the experimental and control situations. Initially, water emptied more rapidly than carbohydrate. However, after 90 minutes, the stomach was emptied regardless of the solution administered (3.2 +/- 1.1% [mean +/- SEM] remaining in the stomach in the carbohydrate group versus 2.3 +/- 1.2% remaining in the stomach in the water group).


CONCLUSIONS
Preoperative anxiety does not prolong gastric emptying. The stomach had been emptied 90 minutes after ingestion of both the carbohydrate-rick drink and water, thereby indicating the possibility of allowing an intake of iso-osmolar carbohydrate-rich fluids before surgery.
Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
J
J
Nygren
A
A
Thorell
H
H
Jacobsson
S
S
Larsson
P O
PO
Schnell
L
L
Hylén
O
O
Ljungqvist
D000328:Adult; D001007:Anxiety / Q000503:physiopathology*; D017081:Cholecystectomy, Laparoscopic; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D017558:Elective Surgical Procedures; D005215:Fasting; D005260:Female; D005526:Food, Formulated; D005746:Gastric Emptying / Q000502:physiology*; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D013312:Stress, Physiological / Q000503:physiopathology*; D013315:Stress, Psychological / Q000503:physiopathology*; D013668:Technetium Tc 99m Aggregated Albumin; D013997:Time Factors
D004040:Dietary Carbohydrates; D013668:Technetium Tc 99m Aggregated Albumin