elationship between preoperative fasting plasma glucose and postoperative pulmonary complications after lung resection in type 2 diabetic patients / 中国胸心血管外科临床杂志

@#Objective     To explore the relationship between preoperative fasting plasma glucose (FPG) and postoperative pulmonary complications (PPCs) in type 2 diabetic patients undergoing elective thoracoscopic lung resection, and provide a reference for prediction and prevention of PPCs in the clinic. Methods     A retrospective analysis was performed on the type 2 diabetic patients who underwent elective thoracoscopic lung resection for the first time in our hospital from January 2017 to March 2021. According to the level of FPG one day before the operation, the patients were divided into three groups: a hypoglycemia group (<6.1 mmol/L), a medium level blood glucose group (≥6.1 mmol/L and <8.0 mmol/L) and a high blood glucose group (≥8.0 mmol/L). Besides, the patients were divided into a PPCs group and a non-PPCs group according to whether PPCs occurred. The risk factors for PPCs were analyzed by logistic regression analysis, and the predictive value of preoperative FPG level on PPCs was estimated by the area under the receiver operating characteristic curve (AUC). Results     A total of 130 patients were included, including 75 (57.7%) males and 55 (42.3%) females with an average age of 63.5±9.0 years. Logistic regression analysis showed that compared to non-PPCs patients, the level of preoperative FPG (P=0.023) and smoking history ratio (P=0.036) were higher and the operation time was longer (P=0.004) in the PPCs patients. High FPG level on preoperative day 1 and longer operation time were associated with PPCs risk. Besides, the preoperative FPG of 6.79 mmol/L was the threshold value to predict the occurrence of PPCs [AUC=0.653, 95%CI (0.559, 0.747), P=0.003]. Conclusion     There is a certain correlation between preoperative FPG level and postoperative PPCs, which may be used as an index to predict the occurrence of PPCs.

Preoperative fasting for the infusion of "yerba mate": a randomized clinical trial with ultrasound evaluation of gastric contents

Abstract Background The traditional infusion of "yerba mate" is widely consumed in South America and exported to countries around the world. Although generally considered a "clear fluid", there is no data to date on the gastric emptying time of yerba mate and safe preoperative fasting intervals. The objective of this study was to evaluate the gastric emptying time of a standardized infusion of yerba mate using bedside ultrasound and compare it with the time confirm of hot and cold tea. Methods This was a prospective, randomized crossover experimental study. Thirty healthy volunteers were evaluated after 8 hours of fasting for both fluids and solids. Gastric antral area and gastric volume were evaluated at baseline and every 20 minutes after drinking 300 mL of randomly assigned infusion of "yerba mate", hot tea, or cold tea. Results The mean gastric emptying time was: 69.7 ± 22.1 min, 63.1 ± 14.5 min, and 64.3 ± 23.5 min for the mate, hot tea, and cold tea respectively. No significant differences were found in emptying time among the infusion groups (p-value = 0.043). When same time measures were compared, the only significant difference detected was between hot teas and mate infusion at 20 minutes (p-value = 0.012) Conclusion Yerba mate infusion has a similar gastric emptying time to that of tea. All subject's gastric volume returned to baseline values by 100 minutes. It is reasonable to recommend a similar fasting period of 2 hours for mate infusion prior to elective surgery.

Uso de eritromicina como procinético para cesárea con cuatro horas de ayuno / Use of erythromycin as a prokinetic for cesarean section with four hours of fasting

Resumen: El ayuno preoperatorio es fundamental como requisito previo a la mayoría de cirugías tanto para las electivas como para las urgencias relativas. Sin embargo, no siempre se cumplen las condiciones idóneas al momento de abordar a un paciente y la falta de ayuno es una condición que puede poner en riesgo la vida del mismo, siendo un factor de riesgo mayúsculo para la broncoaspiración del contenido gástrico. Hasta el momento se cuenta con un reducido arsenal farmacológico de medicamentos que con distinta función e intensidad aceleran el vaciamiento gástrico; la eritromicina no se encuentra en esta lista de manera oficial. A pesar de que ya ha sido utilizada ampliamente con este fin en el ámbito de los procedimientos endoscópicos, no existen aún suficientes reportes en los que se haya puesto a prueba su eficacia procinética en cirugía de urgencia, específicamente una cesárea. Este artículo, además de ofrecer un breve sumario de dicho macrólido, presenta el caso de una paciente embarazada con ingesta alimenticia reciente, en la cual se obtuvieron las condiciones idóneas para cirugía tan sólo cuatro horas después de la administración de la eritromicina.

Abstract: Preoperative fasting is essential as a prerequisite for most surgeries, either elective procedures or relative emergencies. However, the ideal conditions for surgery are not always fulfilled at the time of approaching a patient, and the lack of fasting is a factor that could endanger patient's life, being a major risk factor for bronchoaspiration of gastric content. Until now there is a small pharmacological list of medications that with different function and intensity accelerate gastric emptying, erythromycin is not officially on this list. Despite the fact that it has already been widely used for this purpose in the field of endoscopic procedures, there are not enough reports about its efficacy in emergency surgery, specifically C-section. This article, in addition to offering a brief summary of this macrolide, presents a case in which after erythromycin administration to a pregnant patient with a recent food intake, the ideal conditions for surgery were obtained only four hours later.

Ayuno preoperatorio / Preoperative fasting / Jejum pré-operatório

RESUMEN La broncoaspiración es una de las complicaciones más temidas por parte de los anestesiólogos durante todo el periodo perioperatorio. Desde hace más de un siglo, con el propósito de evitar esta complicación, se ha implementado el ayuno preoperatorio, periodo en el cual el paciente no ingiere alimentos para disminuir el contenido gástrico. El objetivo de este artículo es realizar una revisión de los aspectos más destacados y actuales sobre el ayuno preoperatorio. Para lo cual se realizó una búsqueda manual y digital en diferentes bases de datos como MEDLINE, Scielo, IBECS y Cochrane, con los descriptores siguientes: ayuno preoperatorio, efectos del ayuno. Cuando surge el concepto de ayuno preoperatorio el paciente debía estar más de 8 horas sin alimentarse, provocando esto no solo sensación de hambre, sed, irritabilidad, sino que también provocaba serias alteraciones endocrinometabólicas. Según las últimas recomendaciones, basadas en la evidencia científica, se aconseja seguir los siguientes tiempos de ayuno quirúrgico: 2 h para líquidos claros, 4 h para leche materna, 6 h para la leche de vaca, 8 h para sólidos. En conclusión, se considera que un periodo prolongado sin ingerir alimentos antes de la intervención quirúrgica lejos de ser beneficioso es deletéreo para el buen pronóstico del paciente.

ABSTRACT Bronchoa aspiration is one of the most feared complications by anesthesiologists throughout the perioperative period. For more than a century, in order to avoid this complication, preoperative fasting has been implemented, a period in which the patient does not eat food to decrease the gastric content. The purpose of this article is to review the highlights and current aspects of preoperative fasting. For which a manual and digital search was carried out in different databases such as MEDLINE, Scielo, IBECS and Cochrane, with the following descriptors: preoperative fasting, fasting effects. When the concept of preoperative fasting arises the patient had to spend more than 8 hours without feeding, causing this not only feeling hungry, thirsty, irritating, but also causing serious endocrine-metabolic alterations. According to the latest recommendations, based on scientific evidence, it is advised to follow the following times of surgical fasting: 2 h for clear liquids, 4 h for breast milk, 6 h for cow's milk, 8 h for solids. In conclusion, it is considered that an extended period without ingesting food before surgery far from being beneficial is deterreal for the patient's good prognosis.

RESUMO A aspiração de broncoa é uma das complicações mais temidas pelos anestesiologistas durante todo o período perioperatório. Há mais de um século, para evitar essa complicação, o jejum pré-operatório vem sendo implementado, período em que o paciente não come alimentos para diminuir o teor gástrico. O objetivo deste artigo é rever os destaques e os aspectos atuais do jejum pré-operatório. Para o qual foi realizada uma pesquisa manual e digital em diferentes bancos de dados como MEDLINE, Scielo, IBECS e Cochrane, com os seguintes descritores: jejum pré-operatório, efeitos de jejum. Quando surge o conceito de jejum pré-operatório, o paciente teve que passar mais de 8 horas sem se alimentar, fazendo com que isso não só se sentisse com fome, sede, irritando, mas também causando graves alterações endócrinas-metabólicas. De acordo com as últimas recomendações, com base em evidências científicas, é aconselhável seguir os seguintes tempos de jejum cirúrgico: 2h para líquidos claros, 4h para leite materno, 6h para leite de vaca, 8h para sólidos. Em conclusão, considera-se que um longo período sem ingerir alimentos antes da cirurgia longe de ser benéfico é distensão para o bom prognóstico do paciente.

Comparative ultrasound study of gastric emptying between an isotonic solution and a nutritional supplement / Estudo comparativo do esvaziamento gástrico entre uma solução isotônica e um suplemento nutricional por meio da ultrassonografia

Abstract Background and objectives: Preoperative fasting may lead to undesirable effects in the surgical patient in whom there is a stimulus to ingesting clear liquids until 2 hours before anesthesia. The aim of this study was to evaluate the gastric emptying of two different solutions using ultrasound. Methods: In a prospective, randomized, blind study, 34 healthy volunteers ingested 200 mL of two solutions without residues in two steps: an isotonic solution with carbohydrates, electrolytes, osmolarity of 292 mOsm.L-1, and 36 kcal; and other nutritional supplementation with carbohydrates, proteins, electrolytes, osmolarity of 680 mO.L-1, and 300 kcal. After 2 hours, a gastric ultrasound was performed to assess the antrum area and gastric volume, and the relation of gastric volume to weight (vol.w-1), whose value above 1.5 mL.kg-1 was considered a risk for bronchoaspiration. A p-value <0.05 was considered statistically significant. Results: There was a significant difference between all parameters evaluated 2 hours after the ingestion of nutritional supplementation compared to fasting. The same occurred when the parameters between isotonic solution and nutritional supplementation were compared 2 hours after ingestion. Only one patient had vol.w-1 <1.5 mL.kg-1 2 hours after ingestion of nutritional supplementation; and only one had vol.w-1 >1.5 mL.kg-1 after ingestion of isotonic solution. Conclusion: This study demonstrated that gastric emptying of equal volumes of different solutions depends on their constitution. Those with high caloric and high osmolarity, and with proteins present, 2 hours after ingestion, increased the gastric volumes, which is compatible with the risk of gastric aspiration.

Resumo Justificativa e objetivos: O jejum pré-operatório pode levar a efeitos indesejáveis no paciente cirúrgico, em que há um estimulo à ingestão de líquidos sem resíduos até 2 horas antes da anestesia. O objetivo deste estudo foi avaliar o esvaziamento gástrico de duas soluções diferentes por meio da ultrassonografia. Métodos: Em um estudo prospectivo, randomizado, cego, 34 voluntários saudáveis ingeriram 200 mL de duas soluções sem resíduos, em duas etapas: uma solução isotônica com carboidratos, eletrólitos, osmolaridade de 292 mOsm.L-1 e 36 kcal; e outra suplementação nutricional, com carboidratos, proteínas, eletrólitos, osmolaridade de 680 mOs.L-1 e 300 kcal. Após 2 horas, fez-se ultrassonografia gástrica com avaliação da área do antro e volume gástrico e relação do volume gástrico sobre o peso (vol.p-1), cujo valor acima de 1,5 mL.kg-1 foi considerado risco para broncoaspiração. Considerou-se p< 0,05 como estatisticamente significativo. Resultados: Houve diferença significativa entre todos os parâmetros avaliados 2 horas após a ingestão de suplementação nutricional em relação ao jejum. O mesmo ocorreu quando foram comparados os parâmetros entre solução isotônica e suplementação nutricional 2 horas após a ingestão. Apenas um paciente apresentou vol.p-1< 1,5 mL.kg-1 2 horas após a ingestão de suplementação nutricional; e apenas um apresentou vol.p-1 > 1,5 mL.kg-1, após a ingestão de solução isotônica. Conclusão: Este estudo demonstrou que o esvaziamento gástrico de volumes iguais de diferentes soluções depende de sua constituição. Aqueles com alto valor calórico e alta osmolaridade, e com proteínas presentes, 2 horas após a ingestão, aumentaram os volumes gástricos, compatíveis com o risco de aspiração gástrica.

Ultrasound dynamics of gastric content volumes after the ingestion of coconut water or a meat sandwich. A randomized controlled crossover study in healthy volunteers / Dinâmica ultrassonográfica dos volumes do conteúdo gástrico após a ingestão de água de coco ou sanduíche de carne. Um estudo cruzado controlado e randômico com voluntários saudáveis

Abstract Background: Adequate preoperative fasting is critical in preventing pulmonary aspiration of gastric content. We proposed to study the sonographic gastric content dynamics after the ingestion of liquid or solid food in healthy volunteers and confront it with current guidelines for preoperative fasting times. Methods: We performed a prospective, crossover, evaluator-blinded study involving 17 healthy volunteers of both sexes. Each participant fasted for 10 h and was subjected to a baseline gastric ultrasound, intake of 400 mL of coconut water or a 145 g, 355 kcal meat sandwich, and sonographic gastric evaluations after 10 min and every hour until the stomach was completely empty. Results: At baseline, all subjects had an empty stomach. At 10 min, gastric content [mean + standard deviation (SD)] was 240.4 + 69.3 and 248.2 + 119.2 mL for liquid and solid foods, respectively (p > 0.05). Mean + SD gastric emptying times were 2.5 + 0.7 and 4.5 + 0.9 h for liquid and solid foods, respectively (p < 0.001). For the drink, the stomach was completely empty in 59% and 100% of the subjects after two and four hours, and for the sandwich, 65% and 100% of the subjects after four and seven hours, respectively. Conclusions: Sonographic gastric dynamics for coconut water and a meat sandwich resulted in complete gastric emptying times higher and lower, respectively, than those suggested by current guidelines for preoperative fasting.

Resumo Justificativa: O jejum pré-operatório adequado é fundamental para prevenir a aspiração pulmonar do conteúdo gástrico. Nossa proposta foi avaliar a dinâmica ultrassonográfica do conteúdo gástrico após a ingestão de alimentos líquidos ou sólidos em voluntários sadios e confrontá-la com as diretrizes atuais para os períodos de jejum no pré-operatório. Métodos: Um estudo prospectivo, cruzado e avaliador-cego foi feito com 17 voluntários saudáveis de ambos os sexos. Cada participante jejuou por 10 horas e foi submetido a uma ultrassonografia gástrica na fase basal, ingestão de 400 mL de água de coco ou 355 g de sanduíche de carne e avaliações gástricas ultrassonográficas foram feitas após 10 minutos e a cada hora até o estômago estar completamente vazio. Resultados: Na fase basal, todos os participantes estavam com o estômago vazio. Aos 10 minutos, o conteúdo gástrico [média + desvio-padrão (DP)] foi de 240,4 + 69,3 e 248,2 + 119,2 mL para alimentos líquidos e sólidos, respectivamente (p > 0,05). Os tempos médios de esvaziamento gástrico + DP foram de 2,5 + 0,7 e 4,5 + 0,9 horas para alimentos líquidos e sólidos, respectivamente (p < 0,001). Para a bebida, o estômago ficou completamente vazio em 59% e 100% dos sujeitos após duas e quatro horas; para o sanduíche, o estômago ficou completamente vazio em 65% e 100% dos sujeitos após quatro e sete horas, respectivamente. Conclusões: A dinâmica ultrassonográfica do volume gástrico para água de coco e sanduíche de carne resultou em tempos totais de esvaziamento gástrico maiores e menores, respectivamente, do que os sugeridos pelas diretrizes atuais para o jejum pré-operatório.

Use of ultrasound for gastric volume evaluation after ingestion of different volumes of isotonic solution / Uso da ultrassonografia para avaliação do volume gástrico após ingestão de diferentes volumes de solução isotônica

Abstract Background and objectives: The current preoperative fasting guidelines allow fluid intake up to 2 h before surgery. The aim of this study was to evaluate the gastric volume of volunteers after an overnight fast and compare it with the gastric volume 2 h after ingestion of 200 and 500 mL of isotonic solution, by means of ultrasound assessment. Method: Eighty volunteers underwent gastric ultrasound at three times: after 8 h of fasting; 2 h after ingestion of 200 mL isotonic saline, followed by the first scan; and on another day, 2 h after ingestion of 500 mL of the same solution after an overnight fast. The evaluation was quantitative (antrum area and gastric volume, and the ratio of participants' gastric volume/weight) and qualitative (absence or presence of gastric contents on right lateral decubitus and supine positions. A p-value < 0.05 was considered significant). Results: There was no difference in quantitative variables at measurement times (p > 0.05). Five volunteers (6.25%) had a volume/weight over 1.5 mL kg-1 at fasting and 2 h after ingestion of 200 mL and 6 (7.5%) after 500 mL. Qualitatively, the presence of gastric fluid occurred in more volunteers after fluid ingestion, especially 500 mL (18.7%), although not statistically significant. Conclusion: Ultrasound assessment of gastric volume showed no significant difference, both qualitative and quantitative, 2 h after ingestion of 200 mL or 500 mL of isotonic solution compared to fasting, although gastric fluid content has been identified in more volunteers, especially after ingestion of 500 mL isotonic solution.

Resumo Justificativa e objetivos: As diretrizes recentes de jejum pré-operatório permitem a ingestão de líquidos até 2 horas antes da cirurgia. O objetivo do presente estudo foi, por meio de ultrassonografia gástrica, avaliar o volume gástrico de voluntários após jejum noturno e comparar com o volume gástrico duas horas após a ingestão de 200 e 500 ml de solução isotônica. Método: Foram submetidos à ultrassonografia gástrica 80 voluntários em três momentos: após jejum de 8 horas; 2 horas após a ingestão de 200 ml de solução isotônica, seguida do primeiro exame; e, em outro dia, 2 horas após a ingestão de 500 ml da mesma solução, após jejum noturno. A avaliação foi quantitativa (área do antro e volume gástricos e relação volume gástrico/peso dos participantes) e qualitativa, pela ausência ou presença de conteúdo gástrico nas posições de decúbito lateral direito e supina. Foi considerado significante p < 0,05. Resultados: Não houve diferença nas variáveis quantitativas nos três momentos estudados (p > 0,05). Cinco voluntários (6,25%) apresentaram um volume/peso superior a 1,5 ml.kg-1 em jejum e 2 horas após a ingestão de 200 ml e seis (7,5%) após 500 ml. Qualitativamente, a presença de líquido gástrico ocorreu em mais voluntários após a ingestão de líquidos, principalmente de 500 ml (18,7%), embora sem significância estatística. Conclusão: O volume gástrico pela ultrassonografia não apresenta diferença significativa tanto qualitativa quanto quantitativa, 2 horas após a ingestão de 200 ml ou de 500 ml de solução isotônica em comparação com o jejum, embora conteúdo líquido gástrico tenha sido identificado em mais voluntários, principalmente após a ingestão de 500 ml de solução isotônica.

Qualitative and quantitative ultrasound assessment of gastric content / Avaliação qualitativa e quantitativa do conteúdo gástrico através da ultrassonografia

Summary Objective: Pulmonary aspiration of the gastric contents is one of the most feared complications in anesthesia. Its prevention depends on preoperative fasting as well as identification of risky patients. A reliable diagnostic tool to assess gastric volume is currently lacking. The aim of this study performed on volunteers was to evaluate the feasibility of ultrasonography to identify qualitative and quantitative gastric content. Method: A standardized gastric scanning protocol was applied on 67 healthy volunteers to assess the gastric antrum in four different situations: fasting, after ingesting clear fluid, milk and a solid meal. A qualitative and quantitative assessment of the gastric content in the antrum was performed by a blinded sonographer. The antrum was considered either as empty, or containing clear or thick fluid, or solids. Total gastric volume was predicted based on a cross-sectional area of the antrum. A p-value less than 0.05 was considered statistically significant. Results: For each type of gastric content, the sonographic characteristics of the antrum and its content were described and illustrated. Sonographic qualitative assessment allowed to distinguish between an empty stomach and one with different kinds of meal. The predicted gastric volume was significantly larger after the consumption of any food source compared to fasting. Conclusion: Bedside sonography can determine the nature of gastric content. It is also possible to estimate the difference between an empty gastric antrum and one that has some food in it. Such information may be useful to estimate the risk of aspiration, particularly in situations when prandial status is unknown or uncertain.

Resumo Objetivo: A aspiração pulmonar do conteúdo gástrico é uma das complicações mais temidas em anestesia. A sua prevenção depende do jejum pré-operatório e da identificação dos pacientes de risco. Não há um método diagnóstico que possa acessar o conteúdo gástrico a qualquer momento. O objetivo deste estudo realizado em voluntários foi fazer uma avaliação qualitativa e quantitativa do conteúdo gástrico utilizando a ultrassonografia. Método: O estudo foi realizado em 67 voluntários utilizando uma técnica já descrita de avaliação do antro gástrico, em quatro diferentes situações: jejum, após a ingestão de líquido claro, leite ou refeição sólida. Foi feita uma avaliação qualitativa e quantitativa do conteúdo gástrico por um radiologista que desconhecia o estado gástrico do voluntário. O antro foi considerado vazio, contendo líquido claro ou espesso, ou sólido. O volume total do estômago foi calculado com base na área seccional do antro. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados: Para cada tipo de conteúdo gástrico, as características ultrassonográficas do antro e de seu conteúdo foram descritas e ilustradas. A avaliação qualitativa pode distinguir um estômago vazio de outros com diferentes conteúdos. O volume gástrico calculado foi significativamente maior após a ingestão de qualquer alimento em comparação com o jejum. Conclusão: A ultrassonografia à beira do leito pode determinar a natureza do conteúdo gástrico. Também foi possível diferenciar um antro vazio daquele com algum volume. Essas informações podem ser úteis na determinação do risco de aspiração gástrica, principalmente se a condição gástrica é desconhecida ou incerta.

Effects of Preoperative Honey Drink on Gastric Content, Perioperative Discomfort and Insulin Resistance in Patients Undergoing Open Colorectal Surgery a Randomized, Controlled Trial.

Background and Aims: Preoperative fasting and surgery cause uncomfortable condition, metabolic stress and insulin resistance for the patient. A recent study in colorectal patients indicates that even small elevations of insulin resistance increase the risk of complications. Preoperative carbohydrate can reduce perioperative discomfort and insulin resistance. We investigated the effects of honey as preoperative carbohydrate-rich drink on the residual gastric contents, perioperative discomfort, and insulin resistance. Methods: Randomized, prospective, controlled study. Thirty colorectal cancer patients who underwent elective open colorectal surgery were randomized and divided into the treatment or control group. Patients in treatment group (n = 15) received 250 ml water containing 50 ml honey on the evening and 2-3 hours preoperatively. Control patients (n = 15) underwent overnight fasting. Three different discomfort variables (thirst, hunger and tiredness), residual gastric content, plasma glucose, insulin concentrations and insulin resistance index were recorded during the perioperative period. Results: Patient and operative characteristics did not differ between groups. There was no statistical difference between the two groups with respect to gastric residue content. Subjective well-being was significantly better in the treatment group. Plasma glucose, serum insulin levels and insulin resistance index were found to remain significantly lower in the treatment group. Conclusion: The preoperative honey drink does not appear to alter the volume of residual gastric contents, suggesting that this is safe procedure. Preoperative honey intake is advantageous due to reducing perioperative discomfort and insulin resistance.

Preoperative Oral Carbohydrate Loading in Pancreaticoduodenectomy

Overnight fasting before elective surgery has been the routine to reduce the risk of pulmonary aspiration. Recently, several international guidelines for preoperative fasting recommend to intake carbohydrate-containing fluids up to 2 to 3 hours before the induction of anesthesia to improve postoperative recovery. Based on the recommendations, we developed a "preoperative carbohydrate diet" provided for the preoperative patients. The purpose of this case report is to share our experience of applying preoperative carbohydrate loading prior to surgery.

Pilot Study for Safety and Efficacy of Newly Developed Oral Carbohydrate-Rich Solution Administration in Adult Surgery Patients

PURPOSE: In surgical procedures under general anesthesia, 6 to 8 hours of a nulla per os (NPO; nothing by mouth) has been regarded as essential for prevention of respiratory complication such as aspiration. However, recent studies have reported that oral intake of water and other clear fluids up to 2 hours before induction of anesthesia does not increase respiratory problems. The purpose of this pilot study is to investigate the safety and efficacy of a newly developed carbohydrate-rich solution in elective hernia repair surgery patients. METHODS: A group of 30 adult patients scheduled for elective surgeries under general anesthesia were enrolled. The enrolled study group of patients was permitted to drink a carbohydrate-rich solution until two hours before the operation without volume limitation. Respiratory complication was investigated in the patients using the carbohydrate-rich solution until two hours before induction of general anesthesia. The feelings of thirst, hunger sense were measured pre- and post-operatively. In addition, hoarseness of voice, nausea and vomiting were investigated post-operatively. Satisfaction regarding the short time of fasting was measured. Visual analogue scale (VAS) was used for measurement of these six variables. RESULTS: No patients showed serious respiratory complication such as dyspnea, desaturation. Eight of 30 study group patients complained of mild hoarseness. Most symptoms of hoarseness were mild, with VAS score less than 3 out of 10. Two patients complained 5 out of 10. Six patients felt nausea and 1 patient had vomiting. Pre/post-operative hunger sense and thirst feeling were 1.63/1.60 and 1.90/5.76, respectively. The satisfaction score was 3.00 out of 4. CONCLUSION: Allowing the administration of an oral carbohydrate-rich solution in elective surgery patients requiring general anesthesia is safe without serious respiratory complications and effective in providing satisfaction.

Effect of different types of nutrient solution on preoperative fasting time / 中华临床营养杂志

Objective To discuss the feasibility of preoperative diet by measuring gastric emptying time of carbohydrate and protein nutrient solutions in healthy volunteers.Methods A total of 20 healthy volunteers were collected from August 2013 to May 2014.On the morning of the trial,baseline gastric residual volume of each volunteer was measured with magnetic resonance imaging at 8 a.m.,then each of the 20 healthy volunteers took 12.5％ carbohydrate solution 400 ml (containing 40 g of maltodextrin and 10 g of sucrose) or 12.5％ whey protein solution (containing 50 g whey protein) in 5 minutes.Magnetic resonance imaging was conducted to measure the gastric residual volume every 25 minutes.The volunteers were shifted to the other nutrient solution after a 1-week interval.The gastric emptying time of both nutrient solutions was calculated to generate the curves illustrating the process of gastric emptying.Results The baseline gastric residual volume of the volunteers was (14.90 ± 9.39) ml.The total gastric emptying time of carbohydrate solution was (104.90 ± 27.98) min (95 ％ CI 98.64-111.16 min),while that of whey protein solution was (199.6 ± 34.17) min (95％ CI 184.47-214.73 min).There was a significant difference between these two types of nutrient solution in terms of gastric emptying time (P ＜ 0.000 1).Conclusions The induction of anesthesia could be performed 2 hours after carbohydrate administration,and at least 4 hours after whey protein administration.

The Evaluation of Preoperative Oral Carbohydrate-Rich Solution Effects on Insulin Resistance in Patients undergoing Colectomy

PURPOSE: Reducing preoperative fasting time showed positive effects in several studies, and current guidelines suggest use of a preoperative oral carbohydrate-rich solution before elective surgeries. For elective colectomy procedures, some surgeons favor two-day bowel preparation with diet restriction and administration of laxatives. Aside from patients experiencing the discomfort of nil per os (NPO), there are reported benefits regarding intake of liquids until at least two hours prior to surgery, including decrease in insulin resistance, without additional postoperative surgical complications. The aim of this study is to show the benefits of administration of oral rehydration solution (ORS) two hours prior to surgery for patients undergoing elective colectomy, particularly postoperative insulin resistance. METHODS: This is a randomized controlled trial. All patients undergoing elective colectomy were included and randomized to the control arm or treatment arm. The control arm consisted of the standard bowel preparation and one day of NPO, while the treatment arm consisted of the standard bowel preparation and allowing intake of carbohydrate-rich ORS until 2 hours before surgery. The insulin, glucose, cortisol, and triglyceride levels were determined immediately after induction, 6 hours, 24 hours, and 48 hours post-op, and compared. The homeostatic model assessment-insulin resistance, insulin, glucose, cortisol, and triglyceride levels were determined and compared between the two groups. Anxiety and postoperative complications were monitored and assessed as well. RESULTS: There was less insulin resistance in patients who received ORS 2 hours prior to surgery. Insulin, glucose, cortisol, and triglyceride levels were lower in the treatment group compared to the control group. Taking ORS 1 day prior and until 2 hours before surgery decreased anxiety and discomfort, and alleviated hunger. CONCLUSION: Regarding complications, there was no difference in the incidence of aspiration and postoperative complications. There were fewer wound complications and incidence of paralytic ileus in the treatment group.

Research about shorten preoperative fasting time for patients with digital cerebral angiography / 中国实用护理杂志

Objective To know the feasibiliy and the effects of shorten preoperative fasting time for patients with digital cerebral angiography. Methods Divided 110 patients with digital cerebral angiogra-phy into the observation group and the control group according to their sequence enter the hospital. Routine fasting method was used in the control group, shorten fasting time was used in the observation group, com-pared the incidence rate of fasting-related complications between the two groups. Results The incidence rote of belly discomfort, thirstily, strvation and hypoglyeemic during the digital cerebral angiogrsphy in the con-trol group was significant higher than those of in the observation group, while there were no significant difference about the incidence rate of postoperative complication between the two groups. Conclusions For patients with digital cerebral angiography can shorten the preoperative fasting time properly, which can avoid certain complieaitons.

Anesthetic management for child with idiopathic ketotic hypoglycemia: A case report

Idiopathic ketotic hypoglycemia (IKH) is the common cause of clinically significant non-diabetic hypoglycemia among children. The cause of IKH is decrease in endogenous glucose production after a prolonged fasting. We report the experience of perioperative management for a six-year-old female child undergoing strabismus surgery with a history of IKH. This patient experienced two episodes of severe hypoglycemia and loss of consciousness caused by prolonged fasting at the age of 31 and 41 months. For elective general anesthesia, children should be restricted from fluid and foods to prevent pulmonary aspiration. Because of higher metabolic rate and larger body surface area-to-weight ratio than adult, pediatric patient are more prone to hypovolemia and hypoglycemia during preoperative fasting period. When the preoperative fasting is inevitable in the child with IKH, anesthesiologist should start the parenteral infusion with dextrose-containing fluid and periodically check blood glucose level during perioperative period.

Aspiration Pneumonia at Recovery Room in the Patient Emergency Pelviscopic Salpingectomy, without the Perceptive Sign of Gastric Regurgitation during Perioperative Periods: A case report / 대한마취과학회지

Aspiration pneumonia is considered to be a morbid complication of anesthesia, It was reported that several conditions are associated with an increased frequency of aspiration pneumonia, such as gastroenterological, neurological and, pulmonary diseases. The incidence is also higher in emergency situations than during elective surgery. We encountered aspiration pneumonia after emergency laparoscopic salpingectomy. The patient was 25 years old woman with no prior medical history but had fasted for only 5 h in the preoperative period. During the perioperative period, there were no signs of regurgitation of the gastric contents into the oral cavity. After surgery, the patient was transported to the recovery room in a fully awakened state. However, the patient became cyanotic without vomiting. After physiotherapy, a chest CT scan was performed, and she was diagnosed with aspiration pneumonia. She was admitted to intensive care. Ten days later, she was discharged in a healthy state.

Research about the effects of different preoperative fasting water time on body temperature in preoperative children / 中国实用护理杂志

Objective To investigate the effects of different preoperative fasting water time on body temperature in preoperative children. Methods Divided 350 children into A, B and C group randomly and apply 4 hours preoperative fasting water, 4 hours fasting water added 250～500 ml fluid infusion and 2 hours fasting water respectively. Observe the condition of body temperature, thirst, fidget, crying and vomiting in these 3 groups. Results The incidence rate of preoperative fever in group A was significant higher than that of in the other two groups. The incidence rate of thirst, fidget and crying were significant higher in group A and B than those of in group C, while there was no significant difference among three groups in the incidence rate of vomiting during the course of operation. Conclusion It is a safe method of 8 hours preoperative fasting food and 2 hours fasting water for children, which can effective reduce the incidence rate of preoperative fever and then guarantee the operation.

No Difference in the pH of Gastric Contents between Moderate Obese and Lean Gynecological Patients / 대한마취과학회지

BACKGROUND: Two results have been conflict regarding the pH of gastric contents in obese and lean surgical patients. Obese patients have been considered to have lower pH of gastric contents than lean surgical patients since the study by Vaughan, whereas Harter reported no significant difference in the pH's of obese and lean surgical patients. The author wanted to investigate whether gastric content pH differs or not between obese and lean surgical patients aged from 20 to 60 years. METHODS: Forty patients scheduled for elective abdominal hysterectomy under general endotracheal anesthesia were studied. Group I (n = 20) was composed of lean patients whose body mass indices (BMIs) were between 20 and 25, whereas Group II (n = 20) was composed of obese patients whose BMIs were above 30. Every patient was fasted between 8 and 14 hours preoperatively. Within 10 minutes of endotracheal intubation, gastric contents were withdrawn with a 20 cc syringe connected to a 16F nasogastric tube placed in the stomach. pH and the incidences of pH <2.5, and pH <1.8 were compared. RESULTS: No significant difference in pH (P = 0.199) or in the incidences of pH less than 2.5 (P = 0.23) or 1.8 (P = 0.52) were observed between obese and lean patients. CONCLUSIONS: Obese and lean patients have similar fasting gastric pH's, as long as the obesity is not too severe (BMI under 40).