Carb loading before surgery?

[neuroride]

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Anyone using that carb loading drink the night and morning of surgery? Had surgeon approach me today about starting to use it. He cited some european studies that showed better outcomes and patient satisfaction mainly for colorectal surgery. Pt drinks like 15 oz of the stuff in the evening and then another 15 oz 3 hrs prior to surgery. I had told him that I really hadn't seen anything come through our journals but maybe I missed it also.

 

[WholeLottaGame7]

It's a standard part of our ERAS (enhanced recovery after surgery) protocol for colorectal and major urologic surgery. There are a lot of pieces to it, both surgical and anesthetic. Big thing for us is epidural analgesia/minimize narcotics and goal-directed fluid therapy (LiDCO, esophageal doppler, Cheetah, etc).

 

[gasdoc77]

I've not heard of this but is it to decrease PONV? I've often wondered if the glucagon associated with the stress response/fasted surgical state was in part to blame for the nausea and, conversely, if something that was insulinogenic was given it might antagonize that process.

 

[WholeLottaGame7]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604918/

 

[nap$ter]

Anyone using that carb loading drink the night and morning of surgery? Had surgeon approach me today about starting to use it. He cited some european studies that showed better outcomes and patient satisfaction mainly for colorectal surgery. Pt drinks like 15 oz of the stuff in the evening and then another 15 oz 3 hrs prior to surgery. I had told him that I really hadn't seen anything come through our journals but maybe I missed it also.

a. the science is soft ie outcomes include survey results of "fatigue level" and "well being"
b. numbers are insufficient to support the conclusion of safety from aspiration after 400mL of sugar drink 3 hrs before surgery (although it probably is safe)
c. data is insufficient to support the practice in diabetics (we treat a lot of diabetics; my npo rules are a little stricter for them...)
d. the data regarding other benefits ie length of stay, return of bowel function, ponv, etc looks sketchy and is inconsistent between studies with relatively small n's.

bottom line - my anesthesia group doesn't do this, but i don't care if the surgeon wants the patient to "carb load" preoop so long as it doesn't violate NPO guidelines.

 

[dhb]

It's a standard part of our ERAS (enhanced recovery after surgery) protocol for colorectal and major urologic surgery. There are a lot of pieces to it, both surgical and anesthetic. Big thing for us is epidural analgesia/minimize narcotics and goal-directed fluid therapy (LiDCO, esophageal doppler, Cheetah, etc).

What's major urologic surgery and how long do they stay?

 

[BuzzPhreed]

I smell a fad. Don't underestimate the power of fads in medicine.

 

[WholeLottaGame7]

What's major urologic surgery and how long do they stay?

Cystectomy/cystoprostatectomy, open nephrectomy, pelvic exenterations, etc. LOS varies. Nephrectomies don't usually stay that long, the others will often stay a week plus.

 

[loveumms]

We use it for select patients. According to my colleagues who are studying it, they have had excellent results (if I can remember correctly, they are using PONV, post op blood glucose and patient satisfaction). I think we have done thousands of cases using it and have not had an aspiration as far as I know.

I agree that you have to watch out for fads however, this makes sense. Guess we will have to see if any big studies come out to prove or disprove.

 

[dhb]

Cystectomy/cystoprostatectomy, open nephrectomy, pelvic exenterations, etc. LOS varies. Nephrectomies don't usually stay that long, the others will often stay a week plus.

Ok if you had told me thanks to this you were keeping them under a week i could believe there is an effect but if your LOS is the same as others i don't see the point.

 

[WholeLottaGame7]

Ok if you had told me thanks to this you were keeping them under a week i could believe there is an effect but if your LOS is the same as others i don't see the point.

I don't think a gatorade alone before surgery is going to shave days off of a significant LOS or morbidity/mortality. But even if none of the insulin resistance/return of bowel function stuff is significant and the only difference is improved patient satisfaction, isn't that point enough? What's the downside?

I really think the money shot of the protocol is the epidural.