title: Impact of a Potassium-enriched, Chloride-depleted 5% Glucose Solution on Gastrointestinal Function after Major Abdominopelvic Surgery: Results of a Randomized Controlled Trial.
abstract: Gastrointestinal (GI) complications often delay recovery after radical cystectomy with urinary diversion. The authors investigated if perioperative administration of a potassium-enriched, chloride-depleted 5% glucose solution (G5K) accelerates recovery of GI function.
  
  
  
  This randomized, parallel-group, single-center double-blind trial included 44 consecutive patients undergoing radical cystectomy and pelvic lymph node dissection with urinary diversion. Patients were randomized to receive either a G5K (G5K group) solution or a Ringer's maleate solution (control group). Fluid management aimed for a zero fluid balance. Primary endpoint was time to first defecation. Secondary endpoints were time to normal GI function, need for electrolyte substitution, and renal dysfunction.
  
  
  
  Time to first defecation was not significantly different between groups (G5K group, 93 h [19 to 168 h] and control group, 120 h [43 to 241 h]); estimator of the group difference, -16 (95% CI, -38 to 6); P = 0.173. Return of normal GI function occurred faster in the G5K group than in the control group (median, 138 h [range, 54 to 262 h] vs. 169 h [108 to 318 h]); estimator of the group difference, -38 (95% CI, -74 to -12); P = 0.004. Potassium and magnesium were less frequently substituted in the G5K group (13.6 vs. 54.5% [P = 0.010] and 18.2 vs. 77.3% [P < 0.001]), respectively. The incidence of renal dysfunction (Risk, Injury, Failure, Loss and End-stage kidney disease stage "risk") at discharge was 9.1% in the G5K group and 4.5% in the control group; P = 1.000.
  
  
  
  Perioperative administration of a G5K did not enhance first defecation, but may accelerate recovery of normal GI function, and reduces potassium and magnesium substitution after radical cystectomy and urinary diversion.
authors.affiliation: From the Departments of Anaesthesiology and Pain Medicine (L.M.L., P.Y.W.), Urology (F.C.B.), and Intensive Care Medicine (J.T.), Inselspital, Bern University Hospital, Bern, Switzerland; and Department of Anaesthesia, Kantonsspital, Lucerne, Switzerland (L.M.L.).
authors.forename: Lukas M
authors.initials: LM
authors.lastname: Löffel
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Burkhard
authors.forename: Jukka
authors.initials: J
authors.lastname: Takala
authors.forename: Patrick Y
authors.initials: PY
authors.lastname: Wuethrich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002712:Chlorides; D015653:Cystectomy / Q000009:adverse effects*; D004311:Double-Blind Method; D004573:Electrolytes; D005260:Female; D041981:Gastrointestinal Tract / Q000187:drug effects* / Q000502:physiology*; D005947:Glucose / Q000627:therapeutic use*; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011183:Postoperative Complications / Q000517:prevention & control*; D011188:Potassium / Q000627:therapeutic use*; D011446:Prospective Studies; D000077331:Ringer's Solution; D014547:Urinary Diversion / Q000009:adverse effects; D014882:Water-Electrolyte Balance
chemical_list: D002712:Chlorides; D004573:Electrolytes; D007552:Isotonic Solutions; D000077331:Ringer's Solution; D005947:Glucose; D011188:Potassium