Effects of a Preoperative Carbohydrate Load on Postoperative Recovery in Children: A Randomised, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Nausea and vomiting are common causes for prolonged postoperative length of hospital stay (LOS) in children. A preoperative carbohydrate load may reduce postoperative nausea and vomiting by improving the perioperative metabolic state. The aim of this study was to determine if a preoperative carbohydrate-containing drink would lead to an improvement in the perioperative metabolic state and consequently reduce the incidence of postoperative nausea, vomiting and LOS in children undergoing day-case surgical procedures. METHOD: Randomised, double-blind, placebo-controlled trial involving children aged 4 to 16-years undergoing day-case surgical procedures. Patients were randomised to receive a carbohydrate-containing drink or a placebo. During the induction of anaesthesia, a venous blood gas, and blood glucose and ketone levels were measured. Postoperatively, the incidence of nausea, vomiting, and LOS were documented. RESULTS: 120 patients were randomised with 119/120 (99.2%) undergoing analysis. Blood glucose level was higher in the carbohydrate group; 5.4 mmol/L [3.3-9.4] versus 4.9 mmol/L [3.6-6.5] (p = 0.01). Blood ketone level was lower in the carbohydrate group; 0.2 mmol/L versus 0.3 mmol/L (p = 0.003). The incidence of nausea and vomiting was not different (p > 0.9 and p = 0.8, respectively). LOS in the carbohydrate group was 26 min shorter than the placebo group (p = 0.02). CONCLUSION: Although a preoperative carbohydrate load may provide a more stable metabolic state at the induction of anaesthesia, we did not find a reduction in postoperative nausea and vomiting. A preoperative carbohydrate load has also minimal effects on the postoperative LOS. TYPE OF STUDY: Randomised clinical trial. LEVEL OF EVIDENCE: I.

Insulin pump therapy in children and adolescents: changes in dietary habits, composition and quality of life.

AIM: Continuous subcutaneous insulin infusion (CSII) can improve glycaemic control and dietary flexibility compared with conventional insulin therapies. There is little information on whether users are utilising this increased dietary flexibility, and whether dietary quality is affected. METHODS: A pre-post observational study was undertaken in 28 children and adolescents with type 1 diabetes commencing CSII. Meal pattern and dietary composition was examined from 3-day food diaries completed before and 3-6 months after CSII commencement. Participants completed the Diabetes-Specific Quality of Life for Youth Short Form, and body mass index z-score, and glycated haemoglobin were measured. A second posttest was undertaken at 18 months with those who were still on CSII and contactable (n = 18). RESULTS: Energy and macronutrient intake before and 18 months after CSII commencement were unchanged. Mean snacking events decreased significantly by 1.2 snacks per day (P = 0.009), as did the percentage energy derived from snacks (28.8%, 95% confidence interval (CI) 21.5-36.1 vs. 19.3%, 95% CI 13.2-25.4; P = 0.045). Diabetes-Specific Quality of Life for Youth Short Form score was not significantly affected by pump commencement (25.9 95% CI 18.2-33.6), and body mass index z-score remained similar before and after CSII. Glycated haemoglobin decreased by 0.5% in the 3-6 months following CSII commencement, but was similar to baseline at 18 months. CONCLUSIONS: This study demonstrates that the commencement of CSII did not lead to an abandonment of healthy eating principles, and that patients utilised the increased dietary flexibility to make changes to their snacking pattern.