Preoperative fasting of 2 hours minimizes insulin resistance and organic response to trauma after video-cholecystectomy: a randomized, controlled, clinical trial.
BACKGROUND
Studies showing the improvement of insulin sensitivity by reducing the term of preoperative fasting are mostly done in patients undergoing major operations. More information about the role of shortened preoperative fasting in perioperative metabolism is needed for such elective minor/moderate abdominal procedures as laparoscopic cholecystectomy. We investigated the influence of a carbohydrate-rich drink given 2 h before laparoscopic cholecystectomy on insulin resistance and the metabolic response to trauma.


METHODS
A group of 21 female candidates (18-65 years old) for elective laparoscopic cholecystectomy were randomized to either an 8 h fasting group (control group: n = 10) or to a group receiving 200 ml of a carbohydrate beverage containing 12.5% (25 g, 50 kcal per 100 ml and approximately 285 mOsm) of maltodextrin 2 h before operation (CHO group: n = 11). Blood samples for various biochemical assays were collected both at induction of anesthesia and after the 10th postoperative hour. Insulin resistance was assessed by the HOMA-IR equation (Insulin (microU/ml) x blood glucose (mg/dl)/405).


RESULTS
There were no postoperative complications. Seventy percent (7/10) of the controls and 27.3% (3/11) of the CHO group experienced at least one episode of vomiting (RR = 2.42, 95% Confidence Interval [CI] = 0.88-6.68; P = 0.08). Biochemical analysis showed that serum glucose (P < 0.01), insulin (P < 0.01), lactate/pyruvate ratio (P = 0.03), and triglycerides (P < 0.01) for the control group were higher than for the CHO group. The value of HOMA-IR was significantly greater (P = 0.03) in the conventionally fasted patients than in the CHO group.


CONCLUSIONS
Abbreviation of the period of preoperative fasting and administration of a carbohydrate beverage diminishes insulin resistance and the organic response to trauma.
Faria
Marcelo S M
MS
Department of Surgery, Medical Sciences School,The Federal University of Mato Grosso, Rua Estevão de Mendonça 81 apto 801, 78030-300, Cuiaba, Brazil.
de Aguilar-Nascimento
José E
JE
Pimenta
Osvânio S
OS
Alvarenga
Luis C
LC
Dock-Nascimento
Diana B
DB
Slhessarenko
Natasha
N
D000328:Adult; D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002985:Clinical Protocols; D017558:Elective Surgical Procedures / Q000379:methods; D005215:Fasting / Q000378:metabolism*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008875:Middle Aged; D011134:Polysaccharides / Q000008:administration & dosage / Q000378:metabolism*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D020535:Video-Assisted Surgery; D055815:Young Adult
D001786:Blood Glucose; D007328:Insulin; D011134:Polysaccharides; C008315:maltodextrin