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      Effects of preoperative oral carbohydrate administration on patient well-being and satisfaction in thyroid surgery

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          Abstract

          Background

          Although the positive effects of preoperative oral carbohydrate administration on clinical outcomes followingmajor surgery have been reported continuously, there are few investigations of them in minor surgical patients. Thepresent study was designed to examine the effects of preoperative oral carbohydrate administration on patient well-beingand satisfaction in patients undergoing thyroidectomy.

          Methods

          Fifty adults aged 20–65 years and scheduled for elective thyroidectomy in first schedule in the morning wereallocated to one of two groups. The Control group (n = 25) was requested to obey traditional preoperative fasting aftermidnight prior to the day of surgery. The Carbohydrate group (n = 25) also fasted overnight but drank 400 ml of carbohydrate-richdrink 2 hours before induction of anesthesia. Patient well-being (thirst, hunger, mouth dryness, nauseaand vomiting, fatigue, anxiety and sleep quality) and satisfaction were assessed just before the operating room admission(preoperative) and 6 hours following surgery (postoperative). Other secondary outcomes including oral Schirmer’s testand plasma glucose concentrations were also evaluated.

          Results

          The two groups were homogenous in patient characteristics. Seven parameters representing patient well-beingevaluated on NRS (0–10) and patient satisfaction scored on a 5-point scale were not statistically different between thetwo groups preoperatively and postoperatively. There were no statistically significant differences in secondary outcomes.

          Conclusions

          Preoperative oral carbohydrate administration does not appear to improve patient well-being and satisfactioncompared with midnight fasting in patients undergoing thyroidectomy in first schedule in the morning.

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          Most cited references28

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          Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology.

          This guideline aims to provide an overview of the present knowledge on aspects of perioperative fasting with assessment of the quality of the evidence. A systematic search was conducted in electronic databases to identify trials published between 1950 and late 2009 concerned with preoperative fasting, early resumption of oral intake and the effects of oral carbohydrate mixtures on gastric emptying and postoperative recovery. One study on preoperative fasting which had not been included in previous reviews and a further 13 studies published since the most recent review were identified. The searches also identified 20 potentially relevant studies of oral carbohydrates and 53 on early resumption of oral intake. Publications were classified in terms of their evidence level, scientific validity and clinical relevance. The Scottish Intercollegiate Guidelines Network scoring system for assessing level of evidence and grade of recommendations was used. The key recommendations are that adults and children should be encouraged to drink clear fluids up to 2 h before elective surgery (including caesarean section) and all but one member of the guidelines group consider that tea or coffee with milk added (up to about one fifth of the total volume) are still clear fluids. Solid food should be prohibited for 6 h before elective surgery in adults and children, although patients should not have their operation cancelled or delayed just because they are chewing gum, sucking a boiled sweet or smoking immediately prior to induction of anaesthesia. These recommendations also apply to patients with obesity, gastro-oesophageal reflux and diabetes and pregnant women not in labour. There is insufficient evidence to recommend the routine use of antacids, metoclopramide or H2-receptor antagonists before elective surgery in non-obstetric patients, but an H2-receptor antagonist should be given before elective caesarean section, with an intravenous H2-receptor antagonist given prior to emergency caesarean section, supplemented with 30 ml of 0.3 mol l(-1) sodium citrate if general anaesthesia is planned. Infants should be fed before elective surgery. Breast milk is safe up to 4 h and other milks up to 6 h. Thereafter, clear fluids should be given as in adults. The guidelines also consider the safety and possible benefits of preoperative carbohydrates and offer advice on the postoperative resumption of oral intake.
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            A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients.

            We studied the effects of different preoperative oral fluid protocols on preoperative discomfort, residual gastric fluid volumes, and gastric acidity. Two-hundred-fifty-two elective abdominal surgery patients (ASA physical status I-II) were randomized to preparation with a 12.5% carbohydrate drink (CHO), placebo (flavored water), or overnight fasting. The CHO and Placebo groups were double-blinded and were given 800 mL to drink on the evening before and 400 mL on the morning of surgery. Visual analog scales were used to score 11 different discomfort variables. CHO did not increase gastric fluid volumes or affect acidity, and there were no adverse events. The visual analog scale scores in a control situation were not different between groups. During the waiting period before surgery, the CHO-treated group was less hungry and less anxious than both the other groups (P < or = 0.05). CHO reduced thirst as effectively as placebo (P < 0.0001 versus Fasted). Trend analysis showed consistently decreasing thirst, hunger, anxiety, malaise, and unfitness in the CHO group (P < 0.05). The Placebo group experienced decreasing unfitness and malaise, whereas nausea, tiredness, and inability to concentrate increased (P < 0.05). In the Fasted group, hunger, thirst, tiredness, weakness, and inability to concentrate increased (P < 0.05). In conclusion, CHO significantly reduces preoperative discomfort without adversely affecting gastric contents. Discomfort during the period of waiting before elective surgery can be reduced if patients are prepared with a carbohydrate-rich drink, compared with preoperative oral intake of water or overnight fasting. Visual analog scales can provide useful information about preoperative discomfort in elective surgery patients.
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              Preoperative carbohydrate treatment for enhancing recovery after elective surgery.

              Preoperative carbohydrate treatments have been widely adopted as part of enhanced recovery after surgery (ERAS) or fast-track surgery protocols. Although fast-track surgery protocols have been widely investigated and have been shown to be associated with improved postoperative outcomes, some individual constituents of these protocols, including preoperative carbohydrate treatment, have not been subject to such robust analysis.
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                Author and article information

                Journal
                Korean J Anesthesiol
                Korean J Anesthesiol
                KJAE
                Korean Journal of Anesthesiology
                Korean Society of Anesthesiologists
                2005-6419
                2005-7563
                October 2018
                24 April 2018
                : 71
                : 5
                : 394-400
                Affiliations
                Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
                Author notes
                Corresponding author: Dong-Chan Kim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, 20, Gunji-ro, Deokjin-gu, Jeonju 54907, Korea Tel: 82-63-250-1241, Fax: 82-63-250-1240 Email: dckim@ 123456chonbuk.ac.kr
                Author information
                http://orcid.org/0000-0003-1310-790X
                http://orcid.org/0000-0002-6881-126X
                Article
                kja-d-18-27143
                10.4097/kja.d.18.27143
                6193600
                29684984
                f81866a6-c877-46ef-ade5-fb65b265d110
                Copyright © The Korean Society of Anesthesiologists, 2018

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 June 2017
                : 7 August 2017
                : 22 August 2017
                Categories
                Clinical Research Article

                Anesthesiology & Pain management
                carbohydrate,fasting,glucose,patient satisfaction,thyroidectomy
                Anesthesiology & Pain management
                carbohydrate, fasting, glucose, patient satisfaction, thyroidectomy

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