Among diabetics, Carbohydrate loading < 300 mL 2 h before anesthesia doesn't increase aspiration risk
In patients with type 2 diabetes (T2D), preoperative carbohydrate loading < 300 mL 2 h before anesthesia indication did not affect the gastric volume (GV) or increase reflux and aspiration risk, says a study in the World Journal of Clinical Cases.
The study further found that with preoperative carbohydrate loading of < 200 mL, blood glucose levels did not change significantly. 300 mL carbohydrate loading, however, may further increase blood glucose levels in type 2 diabetes patients before induction of anesthesia.
Consuming carbohydrates two hours before anesthesia is beneficial to the patient's recovery and is a key aspect of enhanced recovery after surgery. Diabetes patients are prone to delayed gastric emptying. Different guidelines for the consumption of carbohydrate in diabetes patients remains controversial owing to concerns about the risk of aspiration, regurgitation, and hyperglycemia. Blood glucose monitoring and ultrasonic gastric volume can comprehensively evaluate the safety and feasibility of preoperative carbohydrate intake in T2D patients.
Against the above background, Xin-Qiang Lin, Department of Anesthesiology, Affiliated Hospital of Putian College, Fujian Province, China, and colleagues aimed to investigate the impact of preoperative carbohydrate loading on GV before anesthesia induction in T2D patients.
The study included 78 T2D patients receiving surgery under general anesthesia from December 2019 to December 2020. They were randomly allocated to four groups receiving 0, 100, 200, or 300 mL of carbohydrate loading 2 h before induction of anesthesia. Before anesthesia, the following parameters were evaluated-Perlas grade, gastric volume per unit weight (GV/W) changes in blood glucose level, and risk of reflux and aspiration.
Based on the study, the researchers found the following:
- No significant difference was found in GV/W among the groups before anesthesia induction.
- The number of patients with Perlas grade II and GV/W > 1.5 mL/kg did not differ among the groups.
- Blood glucose level increased by > 2 mmol/L in patients receiving 300 mL carbohydrate drink, which was significantly higher than that in groups 1 and 2.
"Our study showed the safety and recommended volume of preoperative carbohydrate loading in T2D patients," the authors wrote.
To sum up, it is safe for T2D patients to drink 200 mL of 14.2% carbohydrate 2 h before surgery. "In the future, we will study whether preoperative consumption of 200 mL of 14.2% carbohydrate can reduce postoperative insulin resistance and promote recovery of patients," they conclude.
Reference:
Lin XQ, Chen YR, Chen X, Cai YP, Lin JX, Xu DM, Zheng XC. Impact of preoperative carbohydrate loading on gastric volume in patients with type 2 diabetes. World J Clin Cases 2022; 10(18): 6082-6090 [PMID: 35949825 DOI: 10.12998/wjcc.v10.i18.6082]
