Can pre-operative carbohydrate loading be used in diabetic patients undergoing colorectal surgery?

Authors

  • Affifa Farrukh Department of Digestive Diseases, Leicester General Hospital
  • Kath Higgins Departments of Digestive Diseases and Diabetes, University Hospitals of Leicester NHS Trust, Leicester, UK
  • Baljit Singh Departments of Digestive Diseases and Diabetes, University Hospitals of Leicester NHS Trust, Leicester, UK
  • Robert Gregory Departments of Digestive Diseases and Diabetes, University Hospitals of Leicester NHS Trust, Leicester, UK

DOI:

https://doi.org/10.15277/bjdvd.2014.024

Abstract

The introduction of enhanced recovery after surgery (ERAS) has been associated with shortening post-operative recovery. It achieves such outcomes by minimizing the physical and physiological trauma of surgery. Benefits include superior pain control, reduced duration of ileus, improved pulmonary function and a reduction in thrombo-embolic and cardiac events. Within the ERAS approach the role of oral carbohydrate supplements is based on dealing with insulin resistance which characterizes periods of stress. Aggressive control of blood glucose levels has been shown to benefit both diabetic and non-diabetic patients admitted to intensive care units, however original studies in this area have not been consistently reproducible. The development of low osmolality carbohydrate drinks during the mid 1990s opened up the possibility of extending these benefits to surgical patients by providing them with a carbohydrate load two to three hours prior to anaesthesia. The benefits of the ERAS approach to colorectal surgery has been confirmed in several reports. However, its role in diabetic patients has, as yet, received limited attention. This review examines this limited number of publications and considers the potential benefit of pre- operative carbohydrate loading in all diabetic patients.

References

Scott NB. Enhanced recovery after surgery – the way forward. Reg Anesth Pain Med 2012;37(Suppl 1):E128–E131

Gustafsson UO, Hausel J, Thorell A et al. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 2011;146:571–77. http://dx.doi.org/10.1001/archsurg.2010.309

Van den Berghe G. How does blood glucose control with insulin save lives in intensive care? J Clin Invest 2004;114:1187–95. http://dx.doi.org/10.1172/JCI23506

Bernard C. Leçons sur le Diabete et la Glycogenese Animale. Baillere (1877) Paris.

Ljungqvist O, Nygren J, Thorell A. Modulation of post-operative insulin resistance by pre-operative carbohydrate loading. In: Clinical Nutrition and Metabolism Symposium on’Endocrine and nutritional modulation of the metabolic response to stress’. Proc Nutr Soc 2002;61:329–35.

Thorell A, Nygren J & Ljungqvist O. Insulin resistance – a marker of surgical stress. Curr Opin Clin Nutr Metab Care 1999;2:69–79. http://dx.doi.org/10.1097/00075197-199901000-00012

Zerr K, Furnary A, Grunkemeier G et al. Glucose control lowers the risk of wound infection in diabetics after open heart surgery. Ann Thorac Surg 1997;163:356–61. http://dx.doi.org/10.1016/S0003-4975(96)01044-2

Furnary AP, Zerr KJ, Grunkemeier GL, et al. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 1999;67:352–62. http://dx.doi.org/10.1016/S0003-4975(99) 00014-4

Van der Berghe G, Wouters P, Weeks F et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359–67. http://dx.doi.org/10.1056/NEJMoa011300

NICE-SUGAR Study Investigators, Finfer S, Liu B, Chittock DR et al. Hypoglycemia and risk of death in critically ill patients. N Engl J Med 2012;367:1108–18. http://dx.doi.org/10.1056/NEJMoa1204942

Buchleitner AM, Martínez-Alonso M, Hernández M et al. Perioperative glycaemic control for diabetic patients undergoing surgery. Cochrane Database Syst Rev 2012;9:CD007315

Lanspa MJ1, Hirshberg EL, Phillips GD et al. Moderate glucose control is associated with increased mortality compared with tight glucose control in critically ill patients without diabetes. Chest 2013;143:1226–34. http://dx.doi.org/10.1378/chest.12-2072

Okabayashi T, Shima Y, Sumiyoshi T et al. Intensive versus intermediate glucose control in surgical intensive-care unit patients. Diabetes Care 2014;Mar 12. [Epub ahead of print]

Signal M, Le Compte A, Shaw GM, et al. Glycemic levels in critically ill patients: are normoglycemia and low variability associated with improved outcomes? J Diabetes Sci Technol 2012;6:1030–7. http://dx.doi.org/10.1177/193229681200600506

Nygren J, Soop M, Thorell A et al. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nutr 1998;17:65–71. http://dx.doi.org/10.1016/S0261-5614(98)80307-5

Ljungqvist O, Thorell A, Gutniak M et al. Preoperative nutrition – elective surgery in the fed or the overnight fasted state. Clin Nutr 2001;20(Suppl. 1):167–71. http://dx.doi.org/10.1054/clnu.2001.0462

Tran S, Wolever TH, Errett LE et al. Preoperative carbohydrate loading in patients undergoing coronary artery bypass or spinal surgery. Anesth Analg 2013;117:305–13. http://dx.doi.org/10.1213/ANE.0b013e318295e8d1

Perrone F, da-Silva-Filho AC, Adômo IF et al. Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial. Nutr J 2011;10:66–72. http://dx.doi.org/10.1186/1475-2891-10-66

Noblett SE, Watson DS, Huong H et al. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis 2006;8:563–9. http://dx.doi.org/10.1111/j.1463-1318. 2006.00965.x

Gustafsson UO, Hausel J, Thorell A et al. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 2011;146:571–7. http://dx.doi.org/10.1001/archsurg.2010.309

Eskicioglu C, Forbes SS, Aarts MA et al. Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. J Gastrointest Surg 2009;13:2321-9. http://dx.doi.org/10.1007/s11605-009-0927-2

Zargar-Shostani K, Paddison JS, Booth RJ, et al. A prospective study on the influence of a fast-track program on postoperative fatigue and functional recpvery after major colonic surgery. J Surg Res 2009;154:330–5. http://dx.doi.org/10.1016/j.jss.2008.06.023

Kanamori R, Shimamura M, Kinoshita M et al. Preoperative carbohydrate administration prevents catabolism of fat and protein in patients undergoing elective laparoscopic colectomy. Final report 1AP5-10. Eur J Anaesthesiol 2012;29:17.

Dhatariya K, Flanagan D, Hilton L et al. Management of adults with diabetes undergoing surgery and elective procedures: improving standards (2011). www.diabetes.nhs.uk

Gustaffson UO, Nygren J, Thorell A et al. Pre-operative carbohydrate loading may be used in type 2 diabetes patients. Acta Anaesthesiol Scand 2008;52:946–51. http://dx.doi.org/10.1111/j.1399-6576.2008.01599.x

Jodlowski T, Dobosz M, Noga M. Preoperative oral carbohydrate load in colorectal surgery reduces insulin resistance and may improve outcomes – preliminary results of prospective randomized study. Clin Nutr 2011;6(Supplements PP052):134.

Ziegler MA, Catto JA, Riggs TW et al. Risk factors for anastomotic leak and mortality in diabetic patients undergoing colectomy: analysis from a statewide surgical quality collaborative. Arch Surg 2012;147:600–05. http://dx.doi.org/10.1001/archsurg.2012.77

Breuer JP, von Dossow V, von Heymann C et al. Preoperative oral carbohydrate administration to ASA III-IV patients undergoing elective cardiac surgery. Anesth Analg 2006;103:1099–108. http://dx.doi.org/10.1213/01.ane.0000237415.18715.1d

Downloads

Published

2014-09-12

Issue

Section

Learning from practice

Most read articles by the same author(s)

<< < 1 2