title: Does preoperative oral carbohydrate treatment reduce the postoperative surgical stress response in lumbar disc surgery?
abstract: OBJECTIVE
  Surgical trauma produces metabolic and hormonal responses, which are characterized by insulin resistance. Due to extension of the preoperative fasting period, which increases the magnitude of postoperative insulin resistance, preoperative oral carbohydrates (POC) have been developed.
  
  
  METHODS
  This prospective, randomized, controlled study was performed on 43 ASA I-II patients undergoing elective microsurgical lumbar discectomy. The intervention group received oral carbohydrate solution 800mL the night before and 400mL 2h prior to operation. The other group fasted for 8h prior to operation. Blood samples were obtained the day before the operation, before induction of anesthesia, after skin incision, 1h, 2h, 6h and 24h following skin incision. Blood glucose, plasma insulin, cortisol and interleukin-6 (IL-6) levels were determined. The primary endpoint was to assess the effect of POC treatment on insulin resistance and surgical stress response following lumbar disc surgery. The secondary endpoint was to assess POC's effects on postoperative nausea and vomiting.
  
  
  RESULTS
  The serum insulin levels were higher before induction of anesthesia in the study group and returned to fasted group levels by 2h after skin incision. The plasma IL-6 levels were higher in the intervention group at 6h after the skin incision. There were no differences between the two groups with respect to blood glucose, plasma cortisol levels and the incidence of nausea and vomiting.
  
  
  CONCLUSIONS
  This study suggests that use of POC treatment does not attenuate development of insulin resistance in patients undergoing lumbar disc surgery.
authors.affiliation: University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey. Electronic address: korkmazdilmen@gmail.com.
authors.forename: Ozlem Korkmaz
authors.initials: OK
authors.lastname: Dilmen
authors.affiliation: Istanbul Bilim University, Department of Anesthesiology and Intensive Care, Turkey. Electronic address: eyentur@gmail.com.
authors.forename: Ercument
authors.initials: E
authors.lastname: Yentur
authors.affiliation: University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey. Electronic address: ytunali@yahoo.com.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Tunali
authors.affiliation: University of Istanbul, Cerrahpasa School of Medicine, Central Laboratory, Turkey. Electronic address: hbalci@istanbul.edu.tr.
authors.forename: Huriye
authors.initials: H
authors.lastname: Balci
authors.affiliation: VKF, American Hospital, Department of General Intensive Care Unit, Turkey. Electronic address: bahar.mois@gmail.com.
authors.forename: Mois
authors.initials: M
authors.lastname: Bahar
mesh_terms: D000328:Adult; D004040:Dietary Carbohydrates / Q000008:administration & dosage / Q000494:pharmacology*; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D013122:Spinal Diseases / Q000097:blood* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D004040:Dietary Carbohydrates
keywords: Insulin resistance; Lumbar disc surgery; Preoperative oral carbohydrate solution