title: The Influence of Oral Carbohydrate Solution Intake on Stress Response before Total Hip Replacement Surgery during Epidural and General Anaesthesia.
abstract: OBJECTIVE
  The effects of oral carbohydrate solutions, ingested 2 h prior to operation, on stress response were studied in patients undergoing general or epidural anaesthesia.
  
  
  METHODS
  The study was performed on 80 ASA I-II adult patients undergoing elective total hip replacement, which were randomized to four groups (n=20). Group G patients undergoing general anaesthesia fasted for 8 h preoperatively; Group GN patients undergoing general anaesthesia drank oral carbohydrate solutions preoperatively; Group E patients undergoing epidural anaesthesia fasted for 8 h and Group EN patients undergoing epidural anaesthesia drank oral carbohydrate solutions preoperatively. Groups GN and EN drank 800 mL of 12.5% oral carbohydrate solution at 24:00 preoperatively and 400 mL 2 h before the operation. Blood samples were taken for measurements of glucose, insulin, cortisol and IL-6 levels.
  
  
  RESULTS
  The effect of preoperative oral carbohydrate ingestion on blood glucose levels was not significant. Insulin levels 24 h prior to surgery were similar; however, insulin levels measured just before surgery were 2-3 times higher in groups GN and EN than in groups G and E. Insulin levels at the 24(th) postoperative hour in epidural groups were increased compared to those at basal levels, although general anaesthesia groups showed a decrease. From these measurements, only the change in Group EN was statistically significant (p<0.05). Plasma cortisol levels at the 2(nd) peroperative hour were higher in epidural groups than in general anaesthesia groups. Both anaesthesia techniques did not have an effect on IL-6 levels.
  
  
  CONCLUSIONS
  We concluded that epidural anaesthesia suppressed stress response, although preoperative oral carbohydrate nutrition did not reveal a significant effect on surgical stress response.
authors.affiliation: Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.
authors.forename: M Cem
authors.initials: MC
authors.lastname: Çeliksular
authors.affiliation: Department of Anaesthesiology Aad Reanimation, İstanbul Bilim University School of Medicine, İstanbul, Turkey.
authors.forename: Ayten
authors.initials: A
authors.lastname: Saraçoğlu
authors.affiliation: Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.
authors.forename: Ercüment
authors.initials: E
authors.lastname: Yentür
keywords: Stress response; carbohydrate solution; epidural anaesthesia; general anesthesia; total hip replacement