Clinical and metabolic results of fasting abbreviation with carbohydrates in coronary artery bypass graft surgery.
BACKGROUND
Limited information is available about preoperative fasting abbreviation with administration of liquid enriched with carbohydrates (CHO) in cardiovascular surgeries.


OBJECTIVE
To evaluate clinical variables, security of the method and effects on the metabolism of patients undergoing fasting abbreviation in coronary artery bypass graft (CABG) surgery.


METHODS
Forty patients undergoing CABG were randomized to receive 400 ml (6 hours before) and 200 ml (2 hours before) of maltodextrin at 12.5% (Group I, n=20) or just water (Group II, n=20) before anesthetic induction. Perioperative clinical variables were evaluated. Insulin resistance (IR) was evaluated by Homa-IR index and also by the need of exogenous insulin; pancreatic beta-cell excretory function by Homa-Beta index and glycemic control by tests of capillary glucose.


RESULTS
Deaths, bronchoaspiration, mediastinitis, stroke and acute myocardial infarction did not occur. Atrial fibrillation occurred in two patients of each group and infectious complications did not differ among groups (P=0.611). Patients of Group I presented two days less of hospital stay (P=0.025) and one day less in the ICU (P<0.001). The length of time using dobutamine was shorter in Group I (P=0.034). Glycemic control in the first 6h after surgery was worse for Group II (P=0.012). IR was verified and did not differ among groups (P>0.05). A decline in the endogenous production of insulin was observed in both groups (P<0.001).


CONCLUSIONS
Preoperative fasting abbreviation with the administration of CHO in the CABG was safe. The glycemic control improved in the ICU; there was less time in the use of dobutamine and length of hospital and ICU stay was reduced. However, neither IR nor morbimortality during hospital phase were influenced.
gibranrf@sbccv.org.br
Gibran Roder
GR
Feguri
Paulo Ruiz Lúcio
PR
Lima
Andréa Mazoni
AM
Lopes
Andréa
A
Roledo
Miriam
M
Marchese
Mônica
M
Trevisan
Haitham
H
Ahmad
Bruno Baranhuk de
BB
Freitas
José Eduardo de
JE
Aguilar-Nascimento
D001628:Beverages / Q000009:adverse effects / Q000032:analysis; D001026:Coronary Artery Bypass; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004812:Epidemiologic Methods; D005215:Fasting / Q000502:physiology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects / Q000379:methods*; D011134:Polysaccharides / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
D004040:Dietary Carbohydrates; D011134:Polysaccharides; C008315:maltodextrin