Preoperative Carbohydrate Loading in Gynecological Patients Undergoing Combined Spinal and Epidural Anesthesia

Abstract

Purpose: Preoperative carbohydrate loading (CHO) could improve insulin sensitivity and promoted postoperative recovery under general anesthesia. The aim of this study was to investigate the effects of CHO on gynecological patients. Methods: A group of 58 female patients undergoing surgery were randomized to either fast overnight (the FAST group) or receive 800 ml of CHO the evening before and 400 ml 2 h before anesthesia (the CHO group).The perioperative well-being and the nutritional status, as determined by blood samples for three biochemical assays (the base status, the status after the operation, and the status on the first day after the operation), were recorded. The homeostasis model assessment (HOMA-IR) was used to measure perioperative insulin resistance. The primary endpoint was phantom limb syndrome (PLS) induced by combined spinal and epidural anesthesia (CSEA). Results: The CHO group had significantly lower levels of anxiety (p < 0.01), hunger (p < 0.01), and thirst (p < 0.01); lower incidence of PLS (p < 0.01) and abdominal distention (p < 0.05); earlier occurrence of first flatus (p < 0.01); and fewer hospitalization days (p < 0.01) than patients from the FAST group. Biochemical analysis showed that the levels of interleukin-6 (IL-6) (p < 0.01), C-reactive protein (p < 0.01), cortisol (p < 0.01), glucose (p < 0.01), insulin (p < 0.01), and HOMA-IR (p < 0.01) were lower in the CHO patients. Lactate, pyruvate, and lactate/pyruvate ratios for the CHO patients were also lower than those for the FAST patients. Conclusions: CHO increased perioperative comfort in gynecological patients undergoing CSEA. It also attenuated insulin resistance after the operation and reduced the number of postoperative stress reactions.

Keywords:

• combined spinal and epidural anesthesia
• insulin resistance
• length of hospital stay
• preoperative carbohydrate loading
• phantom limb syndrome

DECLARATION OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.