Abstract
Purpose: To evaluate the metabolic, hormonal and gastric fluid and pH changes after administration of a small volume of different preoperative feeding regimens.
Methods: In a prospective, randomized, double-blind study 375 adult patients were allocated to one of five groups. Patients ingested 60 ml honey, glucose-fructose-sucrose-maltose mixture (GFSM), apple juice or water two hours before surgery or continued their overnight fast (controls). Blood samples were obtained from an indwelling venous catheter before the administration of feeding regimens and before induction of anesthesia for determination of glucose, triglycerides, insulin, epinephrine and norepinephrine concentrations. Before anesthesia induction, patients were asked to grade the degree of thirst and hunger. After tracheal intubation residual gastric volume (RGV) was suctioned through an orogastric tube.
Results: Administration of honey, GFSM, apple juice or water resulted in increases in RGV without changes in the gastric pH. The median RGV values were 15 ml in controls and 20–25 ml in other groups. Thirst was noted after administration of fluids containing sugars. Hunger was noted in the apple juice group. Plasma concentrations of glucose increased and triglycerides decreased after ingestion of fluids containing sugars. Plasma insulin concentrations decreased in GFSM and apple juice groups. Norepinephrine concentrations increased in the control, apple juice and water groups.
Conclusions: Small volumes of fluid increased RGV (P<0.05). Apple juice resulted in increased incidence of thirst and hunger and plasma glucose and norepinephrine concentrations. Compared with GFSM or apple juice, honey had a gentler effect on plasma glucose and insulin concentrations.
Résumé
Objectif: Évaluer les changements métaboliques et hormonaux ainsi que les modifications des liquides et du pH gastrique suivant l’administration d’un faible volume de différentes prescriptions alimentaires.
Méthode: L’étude prospective, randomisée et à double insu a été réalisée auprès de 375 patients adultes répartis au hasard en cinq groupes. Les patients ont pris 60 ml de miel, d’un mélange de glucose-fructose-sucrose-maltose (GFSM), de jus de pomme ou d’eau, deux heures avant une intervention chirurgicale, ou ils sont restés à jeun toute la nuit (témoins). Du sang a été prélevé par cathéter veineux à demeure, avant de donner les liquides et avant l’induction de l’anesthésie, pour déterminer les taux de glucose, de triglycérides, d’insuline, d’adrénaline et de noradrénaline. Les patients ont gradué leur faim et leur soif avant l’induction de l’anesthésie. Après l’intubation endotrachéale, le volume gastrique résiduel (VGR) a été aspiré dans un tube orogastrique.
Résultats: L’administration de miel, d’un mélange de GFSM, de jus de pomme ou d’eau a fait augmenter le VGR sans changer l’acidité gastrique. Le VGR moyen a été de 15 ml dans le groupe témoin et de 20–25 ml dans les autres groupes. La soif a été notée après l’administration de liquides socrés et a faim, avec l’ingestion de jus de pomme. Les concentrations plasmatiques de glucose ont augmenté et celles des triglycérides ont diminué après l’ingestion de liquides sucrés. Le taux plasmatique d’insuline a baissé avec le GFSM et le jus de pomme. Celui de la noradrénaline a diminué chez les témoins, et avec le de jus de pomme et l’eau.
Conclusion: Des volumes faibles de liquides augmentent le VGR (P <0.05). Le jus de pomme provoque une incidence accrue de faim et de soif et une augmentation des concentrations plasmatiques de glucose et de noradrénaline. Comparé au GFSM ou au jus de pomme, le miel a un effet plus modéré sur les concentrations plasmatiques de glucose et d’insuline.
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This study was carried out at King Saud University and was supported by College of Medicine Research Center.
The results of this study were presented at IARS 75th Clinical and Scientific Congress, Fort Lauderdale, Florida, MArch 16–20, 2001.
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Naguib, M., Samarkandimb, A.H., Al-Hattab, Y. et al. Metabolic, hormonal and gastric fluid and pH changes after different preoperative feeding regimens. Can J Anesth 48, 344–350 (2001). https://doi.org/10.1007/BF03014961
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DOI: https://doi.org/10.1007/BF03014961