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Effect of Preoperative 2-Hour Carbohydrate Load on Pediatric Patients Undergoing Elective Surgery: A Randomized
Wafaa Madhy Atia Abdelwahed1, Wafaa Mohamed Abdelelsalam2, Ola Ahmed Taha3
1Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt, tanta.edu.eg.
Insights
Preoperative carbohydrate loading in children undergoing surgery improves metabolic markers and reduces inflammation compared to standard fasting. This approach enhances patient comfort and parental satisfaction, offering a safe alternative for pediatric surgical patients.
Area of Science:
- Pediatric Anesthesiology
- Surgical Nutrition
- Metabolic Medicine
Background:
- Prolonged preoperative fasting in pediatric patients can cause metabolic disturbances and discomfort.
- Standard fasting protocols may negatively impact physiological markers in children undergoing surgery.
Purpose of the Study:
- To evaluate the systemic effects of different preoperative carbohydrate (CHO) loads in pediatric patients undergoing elective surgery.
- To compare the impact of apple juice, anhydrous glucose, and water on metabolic and inflammatory markers.
Main Methods:
- A randomized single-blinded controlled trial involving 90 children (5-10 years old) scheduled for elective surgery.
- Three groups received either apple juice, anhydrous glucose, or water 2 hours before surgery, adhering to standard fasting guidelines.
- Assessment of inflammatory markers, insulin resistance (IR), random blood sugar, and parental satisfaction.
Main Results:
- Carbohydrate loading (apple juice and glucose) significantly reduced inflammatory markers compared to water.
- Insulin resistance markers were better preserved with carbohydrate loading, although blood sugar levels showed transient variations.
- Parental satisfaction was significantly higher in groups receiving carbohydrate loads versus water.
Conclusions:
- Preoperative carbohydrate loading is a safe and effective alternative to standard fasting in pediatric elective surgery.
- CHO loading improves metabolic profiles, reduces the inflammatory response, and enhances parental satisfaction.
- This strategy optimizes patient outcomes and comfort in the perioperative period for pediatric surgical patients.
Background:
Preoperative prolonged fasting can lead to metabolic disturbances and discomfort in pediatrics. This work aimed to assess the systemic effect of different preoperative carbohydrate (CHO) loads in pediatrics undergoing elective surgery.
Methods:
This randomized single-blinded controlled trial was performed on 90 children, aged 5-10 years old, who were scheduled for elective surgery. Three equal groups were randomly assigned to patients. 2 h before surgery, patients received 10 mL/kg apple juice in Group 1, 1.75 mg/kg anhydrous glucose in Group 2, or water in Group 3. All patients followed standard fasting guidelines.
Results:
Inflammatory markers were notably elevated in Group 3 than in Groups 1 and 2 at the induction of anesthesia and 4 h after operation (p < 0.001). Insulin resistance (IR) markers significantly decreased in Group 3 at the induction of anesthesia but were significantly higher at 4 h after operation than in Groups 1 and 2 (p < 0.05). Random blood sugar was notably lower in Group 3 than in Groups 1 and 2 at induction of anesthesia and intraoperative but was significantly higher at 4 h after operation (p < 0.05). The patients' parents were significantly more satisfied in Groups 1 and 2 in comparison to Group 3 (p = 0.003).
Conclusions:
In pediatrics undergoing elective surgeries, preoperative CHO loading is a safe alternative to standard fasting as it results in better preservation of IR markers, inflammatory response, and parents' satisfaction levels.
Trial Registration:
ClinicalTrials.gov identifier: NCT06833671.
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