title: Preoperative conditioning with oral carbohydrate loading and oral nutritional supplements can be combined with mechanical bowel preparation prior to elective colorectal resection.
abstract: OBJECTIVE
  Preoperative conditioning with oral fluid and carbohydrate (CHO) loading allows the patient to undergo surgery in the fed state and is associated with reduced postoperative insulin resistance. Further benefit may accrue from oral nutritional supplements (ONS) to counteract the fasting associated with mechanical bowel preparation (MBP). In this study we assess the ability to prescribe, dispense and have patients comply with a protocol combining preoperative ONS and CHO/fluid loading during MBP.
  
  
  METHODS
  One hundred and forty-seven patients undergoing elective left colonic or rectal resection were recruited to an Enhanced Recovery after Surgery (ERAS) programme. All patients were prescribed MBP (2 sachets Picolax). On the daytime prior to surgery, eligible patients were prescribed 2 x 200 ml of ONS (Fortijuice, Nutricia) and in the evening 800 ml oral CHO/fluid loading (Preop(R), Nutricia,). Patients were prescribed a further 400 ml of oral/CHO/fluid on the morning of surgery 2 h prior to induction of anaesthesia. Protocol compliance was audited prospectively.
  
  
  RESULTS
  One hundred and forty-seven patients received MBP. Twenty-three patients were ineligible for oral CHO/fluid loading [diabetes (n = 22), allergy to lemon flavoured drinks (n = 1)]. Fourteen patients did not receive the preoperative CHO drinks due to failure to prescribe (n = 8) or dispense (n = 6). One hundred and ten patients were dispensed the combined ONS and CHO/fluid loading regimen, compliance rates were 83% with ONS, 80% with CHO/fluid loading and 74% with both.
  
  
  CONCLUSIONS
  Approximately 74% of patients undergoing MBP can comply with preoperative conditioning with ONS and CHO/fluid loading. Prescription and dispensing requires close attention to detail.
authors.affiliation: Department of Clinical and Surgical Sciences, Royal Infirmary of Edinburgh, Edinburgh, UK. paul.hendry@ed.ac.uk
authors.forename: P O
authors.initials: PO
authors.lastname: Hendry
authors.forename: A
authors.initials: A
authors.lastname: Balfour
authors.forename: M A
authors.initials: MA
authors.lastname: Potter
authors.forename: B J
authors.initials: BJ
authors.lastname: Mander
authors.forename: D C C
authors.initials: DC
authors.lastname: Bartolo
authors.forename: D N
authors.initials: DN
authors.lastname: Anderson
authors.forename: K C H
authors.initials: KC
authors.lastname: Fearon
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002400:Cathartics; D002985:Clinical Protocols; D003106:Colon / Q000601:surgery; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D019587:Dietary Supplements; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012007:Rectum / Q000601:surgery; D007507:Therapeutic Irrigation
chemical_list: D001786:Blood Glucose; D002400:Cathartics; D004040:Dietary Carbohydrates