Safety and efficacy of oral rehydration therapy until 2 h before surgery: a multicenter randomized controlled trial.

PURPOSE: In many countries, patients are generally allowed to have clear fluids until 2-3 h before surgery. In Japan, long preoperative fasting is still common practice. To shorten the preoperative fasting period in Japan, we tested the safety and efficacy of oral rehydration therapy until 2 h before surgery. METHODS: Three hundred low-risk patients scheduled for morning surgery in six university-affiliated hospitals were randomly assigned to an oral rehydration solution (ORS) group or to a fasting group. Patients in the ORS group consumed up to 1,000 ml of ORS containing balanced glucose and electrolytes: 500 ml between 2100 the night before surgery and the time they woke up the next morning and 500 ml during the morning of surgery until 2 h before surgery. Patients in the fasting group started fasting at 2100 the night before surgery. Primary endpoints were gastric fluid volume and pH immediately after anesthesia induction. Several physiological measures of hydration and electrolytes including the fractional excretion of sodium (FENa) and the fractional excretion of urea nitrogen (FEUN) were also evaluated. RESULTS: Mean (SD) gastric fluid volume immediately after anesthesia induction was 15.1 (14.0) ml in the ORS group and 17.5 (23.2) ml in the fasting group (P = 0.30). The mean difference between the ORS group and fasting group was -2.5 ml. The 95% confidence interval ranged from -7.1 to +2.2 ml and did not include the noninferior limit of +8 ml. Mean (SD) gastric fluid pH was 2.1 (1.9) in the ORS group and 2.2 (2.0) in the fasting group (P = 0.59). In the ORS group, mean FENa and FEUN immediately after anesthesia induction were both significantly greater than those in the fasting group (P < 0.001 for both variables). The ORS group reported they had been less thirsty and hungry before surgery (P < 0.001, 0.01). CONCLUSIONS: Oral rehydration therapy until 2 h before surgery is safe and feasible in the low-risk Japanese surgical population. Physicians are encouraged to use this practice to maintain the amount of water in the body and electrolytes and to improve the patient's comfort.

Alterations in bone turnover by isoflavone aglycone supplementation in relation to estrogen receptor α polymorphism.

Soybean isoflavones have structural similarity to estrogen and have attracted much attention due to their prevention of postmenopausal symptoms. It is critical for women to maintain a high bone mineral density (BMD) prior to menopause to prevent osteoporosis. In the present study, the effect of isoflavone aglycone (IA) supplementation on bone turnover was examined in relation to the estrogen receptor α (ERα) polymorphism. Natural isoflavones are glycosides that must be hydrolyzed to aglycones by intestinal microflora to have an effect. To avoid interference by flora, IA (30 mg/day) (but not isoflavones) or a placebo were administered as a supplement for 3 months to a Japanese population consisting of 81 premenopausal women. Due to variations in the intestinal flora, some but not all subjects were able to further metabolize IA into equol. Differences between equol producers and non-producers were also considered. To estimate BMD, the osteo-sono-assessment index (OSI) was determined by measuring bone density at the calcaneus and levels of bone biochemical markers (bone-specific alkaline phosphatase, α-carboxylated osteocalcin, undercarboxylated osteocalcin and deoxypridinoline) before and after supplementation. DNA samples from the subjects were examined for the presence of the XbaI restriction fragment length polymorphism (RFLP) in intron 1. According to univariate analysis, IA had a favorable effect on the OSI of subjects with the X allele, with X designated RFLP undigested by XbaI, although the difference was not statistically significant. Alterations in the levels of bone biochemical markers were also not significant. Thus, a further logistic regression analysis was performed. This indicated that subjects with the XX homozygote administered the IA supplement were less likely to have reduced OSI values. Although equol has been proposed to have the highest phytoestrogen activity, its effect was not apparent. Thus, low-dose IA supplementation is useful for maintaining BMD in premenopausal XX subjects, independent of equol.

A comparison of changes in cardiac preload variables during graded hypovolemia and hypervolemia in mechanically ventilated dogs.

We developed an online monitoring system to measure systolic blood pressure variation (SPV) and its down (dDown) and up components, along with pulse pressure variation (dPP). Using the system, we compared different cardiac preload indicators-such as stroke volume variation (SVV) and corrected flow time (FTc)-along with central venous pressure and pulmonary artery occlusion pressure in mechanically-ventilated dogs during normovolemia, graded hypovolemia (-200 and -350 mL), and hypervolemia (+200 and +350 mL). We simultaneously measured these preload indicators along with global hemodynamic variables and investigated their validity and limitations to access preload changes. SPV increased from 4.8 +/- 1.4 mm Hg at baseline to 11.2 +/- 1.8 mm Hg during hypovolemia (-350 mL), but it did not change significantly during hypervolemia. Similar changes were observed with dDown, dPP, and SVV. FTc, conversely, increased during hypervolemia but remained unchanged during hypovolemia. The results of this study indicate that SPV, dDown, dPP, and SVV are useful indicators of hypovolemia, but not of hypervolemia. Conversely, hypovolemia could not be detected reliably by FTc, but it does reflect blood volume changes during hypervolemia. Although SPV, dDown, and dPP measurements require no additional invasion and cost beyond arterial cannulation, their limits must be kept in mind for the monitoring of blood volume status in mechanically-ventilated patients.