The effects of preoperative carbohydrate loading and fast avoidance on the glucose metabolic response to surgery at the buea, limbe regional hospitals and kumba district

CaHReF 20116, Yaoundé Conges hall, 23 – 26 August 2016 , PL103

There is usually a stress response to surgery that involves catabolism and gluconeogenesis resulting in Postoperative Hyperglycemia (HG). This post-operative HG is a risk factor for postoperative complications. Preoperative fasting further aggravates this response. A carbohydrate (CHO) drink instead of fasting is expected to increase insulin sensitivity and reduce postoperative HG.

The aim of this report is to minimize the incidence of post-operative HG and its associated complications by reducing the pre-operative fasting period.

To compare the mean blood glucose and compare postoperative complications in patients who are fasted preoperatively and those who receive a CHO drink before surgery.

We carried out a hospital-based prospective case control study. 70 patients who were scheduled for elective surgery were conveniently sampled to either a case (CHO) or a control (FAST) group. Subjects in the CHO group consumed 660mls of Malta Guinness® the night before surgery followed by 330mls the morning before surgery 3 hours before anesthesia. Those in the control group fasted overnight atleast 8 hours before surgery. Postoperative capillary blood glucose was measured 2hours after surgery and the next morning after surgery.

We recorded no anesthetic complications as a result of preoperative energy drink consumption. The mean blood glucose the morning after surgery was significantly higher in the control than in the case group giving us means of 146.20mg/dl (SD±38.36) and 123.06mg/dl (SD±26.64)), p= 0.004. Postoperative infections were higher in the control group than in the case group (31.43%; and 8.57%; 95% C.I: 1.2275-19.4715, p=0.033). Other significant differences between the case and control groups were ; age(p=0.028), duration of surgery(p=0.025), type of surgery(p=0.012). In multivariate analyses, age(p=0.048,OR=1.04) and postoperative infections (P=0.047,OR=0.17) were independently associated between the two groups. 

The mean postoperative blood glucose was lower in patients supplemented with a carbohydrate drink three hours before surgery than those who fasted atleast 8hours. Postoperative infections were also significantly lower in the case group than the control group. Therefore preoperative oral CHO loading is safe and can reduce postoperative hyperglycemia and postoperative infection but this however warrants further studies to reassess traditional fasting practices before surgery. 

Preoperative fasting, CHO loading, Surgery and Blood glucose