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Impact of oral carbohydrate consumption prior to cesarean delivery on preoperative well-being: a randomized interventional study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Oral carbohydrate consumption before surgery improves insulin sensitivity, cardiac output and well-being, and shortens hospital stays without adverse effects. No work has compared higher-dose carbohydrate beverages made for preoperative consumption to common, commercial oral rehydration solutions with lower carbohydrate concentrations.

Methods

We recruited low-risk women undergoing scheduled cesarean deliveries with planned spinal anesthesia. Participants were randomized to one of three groups: those who consumed Clearfast® beverage, those who consumed Gatorade Thirst Quencher® beverage, or fasting control. Participants in the two beverage groups received 710 mL of the appropriate beverage the night before surgery and 355 mL 2 h before surgery. Participants in the control group fasted after midnight the night before surgery. Two hours before surgery, we recorded baseline patient well-being using visual analogue scales, followed by beverage consumption for subjects in the beverage groups. One hour later, we repeated the same assessment. Additional recorded measures included cord blood glucose level, intraoperative variables, breastfeeding success, and a quality of recovery assessment administered 1 day after surgery.

Results

Forty-seven patients were recruited: 15 received Clearfast®, 17 received Gatorade Thirst Quencher®, and 15 patients fasted after midnight. Group differences in change in patient well-being using visual analog scales were analyzed using linear regression. Both beverage-consuming groups showed significant improvements in patient well-being using visual analog scales while fasted patients showed no change.

Conclusion

Either a common oral rehydration beverage or a higher-dose carbohydrate beverage consumed preoperatively resulted in superior well-being compared to fasting. No differences in other outcomes were noted.

Trial registration

This study was registered on ClinicalTrials.gov with clinical trial registration number: NCT02684513.

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References

  1. Rothman D, Magnusson I, Katz LD, Shulman RG, Shulman GI (1991) Quantitation of hepatic glycogenolysis and gluconeogenesis in fasting humans with 13C NMR. Science 254(5031):573–576

    Article  CAS  Google Scholar 

  2. Nygren J (2006) The metabolic effects of fasting and surgery. Best Pract Res Clin Anaesthesiol 20(3):429–438

    Article  CAS  Google Scholar 

  3. Awad S, Constantin-Teodosiu D, Macdonald IA, Lobo DN (2009) Short-term starvation and mitochondrial dysfunction—a possible mechanism leading to postoperative insulin resistance. Clin Nutr 28(5):497–509

    Article  CAS  Google Scholar 

  4. Kaska M, Grosmanova T, Havel E et al (2010) The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery—a randomized controlled trial. Wien Klin Wochenschr 122(1–2):23–30

    Article  CAS  Google Scholar 

  5. Quiros G, Ware J (1983) Cardio-vascular and metabolic alterations caused by hemorrhage in fed and starved rats. Acta Physiol Scand 117(3):397–403

    Article  CAS  Google Scholar 

  6. van Hoorn EC, Middelaar-Voskuilen MC, van Limpt CJ et al (2005) Preoperative supplementation with a carbohydrate mixture decreases organ dysfunction-associated risk factors. Clin Nutr 24(1):114–123

    Article  Google Scholar 

  7. Oldfield GS, Commerford PJ, Opie LH (1986) Effects of preoperative glucose-insulin-potassium on myocardial glycogen levels and on complications of mitral valve replacement. J Thorac Cardiovasc Surg 91(6):874–878

    Article  CAS  Google Scholar 

  8. Berggren H, Ekroth R, Hjalmarson A et al (1985) Enhanced myocardial protection from preoperative carbohydrate infusion in addition to maintained beta-blockade. J Cardiovasc Surg 26(5):454–456

    CAS  Google Scholar 

  9. Lolley DM, Myers WO, Ray JF 3rd, Sautter RD, Tewksbury DA (1985) Clinical experience with preoperative myocardial nutrition management. J Cardiovasc Surg 26(3):236–243

    CAS  Google Scholar 

  10. Lazar HJ, Philippides G, Fitzgerald C, Lancaster D, Shemin RJ, Apstein C (1997) Glucose-insulin-potassium solutions enhance recovery after urgent coronary artery bypass grafting. J Thorac Cardiovasc Surg 113(2):354–362

    Article  CAS  Google Scholar 

  11. Breuer JP, van Dossow V, von Heymann C et al (2006) Preoperative oral carbohydrates administration to ASA III-IV patients undergoing elective cardiac surgery. Anesth Analg 103(5):1099–1108

    Article  Google Scholar 

  12. Wilson RD, Caughey AB, Wood SL et al (2018) Guidelines for antenatal and preoperative care in cesarean delivery: enhanced recovery after surgery society recommendations (part 1). Am J Obstet Gynecol 219(6):523.e1–523.e5

    Article  Google Scholar 

  13. Caughey AB, Wood SL, Macones GA et al (2018) Guidelines for antenatal and preoperative care in cesarean delivery: enhanced recovery after surgery society recommendations (part 2). Am J Obstet Gynecol 219(6):533–544

    Article  Google Scholar 

  14. Singata M, Tranmer J, Gyte GML (2013) Restricting oral fluid and food intake during labour. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003930.pub2

    Article  PubMed  Google Scholar 

  15. Angueira AR, Ludvik AE, Reddy TE, Wicksteed B, Lowe WL Jr, Layden BT (2015) New insights into gestational glucose metabolism: Lessons learned from 21st century approaches. Diabetes 64(2):327–334

    Article  CAS  Google Scholar 

  16. Bilku DK, Dennison AR, Hall TC, Metcalfe MS, Garcea G (2014) Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl 96(1):15–22

    Article  CAS  Google Scholar 

  17. Kratzing C (2011) Pre-operative nutrition and carbohydrate loading. Proc Nurt Soc 70(3):311–315

    Article  CAS  Google Scholar 

  18. Smith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J (2014) Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009161.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  19. Nakamura M, Uchida K, Akahane M, Watanabe Y, Ohtomo K, Yamada Y (2014) The effects on gastric emptying and carbohydrate loading of an oral nutritional supplement and an oral rehydration solution: a crossover study with magnetic resonance imaging. Anesth Analg 118(6):1268–1273

    Article  CAS  Google Scholar 

  20. Yildiz H, Gunal SE, Yilmaz G, Yucel S (2013) Oral carbohydrate supplementation reduces preoperative discomfort in laparoscopic cholecystectomy. J Invest Surg 26(2):89–95

    Article  Google Scholar 

  21. Hausel J, Nygren J, Lagerkranser M et al (2001) A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg 93(5):1344–1350

    Article  CAS  Google Scholar 

  22. Ljungqvist O, Nygren J, Thorell A (2002) Modulation of post-operative insulin resistance by pre-operative carbohydrate loading. Proc Nutr Soc 61(3):329–336

    Article  CAS  Google Scholar 

  23. Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF (2006) Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis 8(7):563–569

    Article  CAS  Google Scholar 

  24. Wang ZG, Wang Q, Wang WJ, Qin HL (2010) Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. Br J Surg 97(3):317–327

    Article  CAS  Google Scholar 

  25. Singh BN, Dahiya D, Bagaria D et al (2015) Effects of preoperative carbohydrates drinks on immediate postoperative outcome after day care laparoscopic cholecystectomy. Surg Endosc 29(11):3267–3272

    Article  Google Scholar 

  26. Splinter WM, Stewart JA, Muir JG (1989) The effect of preoperative apple juice on gastric contents, thirst and hunger in children. Can J Anaesth 36(1):55–58

    Article  CAS  Google Scholar 

  27. Splinter WM, Stewart JA, Muir JG (1990) Large volumes of apple juice preoperatively do not affect gastric pH and volume in children. Can J Anaesth 37(1):36–39

    Article  CAS  Google Scholar 

  28. Committee on Obstetric Practice, American College of Obstetricians and Gynecologists (2009) ACOG Committee Opinion No. 441: Oral intake during labor. Obstet Gynecol 114(3):714

    Article  Google Scholar 

  29. American Society of Anesthesiologists Task Force on Obstetric Anesthesia (2007) Practice guidelines for obstetric anesthesia. Anesthesiology 106(4):843–863

    Article  Google Scholar 

  30. Bar G, Sheiner E, Lezerovizt A, Lazer T, Hallak M (2008) Early maternal feeding following caesarean delivery: a prospective randomized study. Acta Obstet Gynecol Scand 87(1):68–71

    Article  Google Scholar 

  31. Voigt M, Frolich CW, Huttel C et al (2013) Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia. Med Sci Monit 19:993–1000

    Article  CAS  Google Scholar 

  32. Myles PS, Weitkamp B, Jones K, Melick J, Hensen S (2000) Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth 84(1):11–15

    Article  CAS  Google Scholar 

  33. Nordenstrom J, Carpentier YA, Askanazi J et al (1983) Free fatty acid mobilization and oxidation during total parenteral nutrition in trauma and infection. Ann Surg 198(6):725–735

    Article  CAS  Google Scholar 

  34. Kindler CH, Harms C, Amsler F, Ihde-Scholl T, Scheidegger D (2000) The visual analog scale allows effective measurement of preoperative anxiety and detection of patients’ anesthetic concerns. Anesth Analg 90(3):706–712

    Article  CAS  Google Scholar 

  35. Boogaerts JG, Vanacker E, Seidel L, Albert A, Bardiau FM (2000) Assessment of postoperative nausea using a visual analogue scale. Acta Anaesthesiol Scand 44:470–474

    Article  CAS  Google Scholar 

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Funding

This study was supported by a grant from the I. Heermann Anesthesia Foundation.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA

    Adam L. Wendling & Megan Koenig

  2. Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA

    Sharon Y. Byun

  3. Departments of Anesthesiology and Orthopedics, University of Florida College of Medicine, Gainesville, FL, USA

    Terrie Vasilopoulos

Authors
  1. Adam L. Wendling
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  2. Sharon Y. Byun
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  3. Megan Koenig
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  4. Terrie Vasilopoulos
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Contributions

ALW Protocol/project development, Data collection and management, Data analysis, Manuscript writing/editing. SYB Protocol/project development, Data collection and management, Data analysis, Manuscript writing/editing. MK Data collection and management, Data analysis. TV: Data analysis, Manuscript writing/editing.

Corresponding author

Correspondence to Adam L. Wendling.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee (University of Florida Institutional Review Board 201501150) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Wendling, A.L., Byun, S.Y., Koenig, M. et al. Impact of oral carbohydrate consumption prior to cesarean delivery on preoperative well-being: a randomized interventional study. Arch Gynecol Obstet 301, 179–187 (2020). https://doi.org/10.1007/s00404-020-05455-z

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  • DOI: https://doi.org/10.1007/s00404-020-05455-z

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