| Surgical stress induces the release of stress hormones, such as catecholamines, glucagon and growth hormone, and is the development of insulin resistance (IR) after operation. It usually results in a reduction of the insulin sensitivity (IS) and a compensatory increase of insulin release. Therefore, symptoms of elevated levels of blood glucose and insulin, just like a state of metabolism similar to non-insulin-dependent diabetes mellitus, can appear for patients who do not suffer from diabetes mellitus during elective surgery. In addition, the overnight preoperative fasting (Nothing per-os, NPO) has not only impaired to attenuate the preoperative discomfort, for instance, hunger, thirst and anxiety, but added to the serious reduction of IS as well. However, most of the clinical colleagues fail to realize the effect of NPO on the psychology and IS of the patients, and there was rarely administration of preoperative oral liquid in order to prevent IR after surgery in China. The objective of this study is to investigate the effect of preoperative oral carbohydrate treatment on psychology and insulin sensitivity of patients undergoing coronary artery bypass grafting surgery (CABG).Objective 1) To evaluate the validity and utility of the visual analog scales (VAS) to measure preoperative discomfort, compared with the standard State Anxiety Inventory (SAI). 2) To investigatethe effect of NPO and elective CABG on the patients' psychology and IS. 3) To evaluate the effect of treating patients with carbohydrate drink at some time before surgery on the psychology and IS in comparison with NPO.Methods A total of 33 consecutive adult patients scheduled for elective cardiothoracic surgery were firstly included in the study. They were scored with VAS and SAI respectively, and SAI was employed to examine the validity and utility of VAS.Then, thirty else patients who were about to undergo elective CABG surgery were randomly assigned two preoperative treating groups with equal size: one preparing with oral glucose (G), and another fasting from midnight till surgery (F). In both two groups, there was food restriction after the last meal at six o'clock the night before the operation. However, during the evening before surgery, each patient in the G group was allowed to consume extra 600 ml of a glucose-rich drink (16.7% glucose). Besides, the same drink of 300 ml was respectively taken drink at least 3 hours (h) before surgery in the patients of G group. All patients of the two groups were scored their subjective sense of anxiety and discomfort with SAI and VAS on the following different occasions: 1) the day after hospitalization, 2) the day before surgery, 3) 2 h before surgery.Venous blood samples were drawn from each group on different points during the operation. The times of sampling were: 1) the day after hospitalization, 2) the day before surgery, 3) the morning of surgery, 4) induction of anesthesia, 5) giving heparin, 6) closure of thorax cavity, 7) 1 and 24 h after surgery, 8) 2, 3 and 7 days (d) after surgery. At each sampling time, approximately 3 ml of blood was collected for subsequently analysis of blood glucose and insulin.Blood glucose was immediately measured with glucose oxidase method. Then, all samples were rapidly centrifuged for 10 minutes at 3000g. The supernatants were stored at -70 癈 before batch analysis of insulin. Serum insulin was determined using radioimmunoassay method with an antibody.Results In this study, a high test-retest reliability assessed by the correlation was found (r = 0.98, P <0.01). There was also a significant correlation between SAI and VAS (r = 0.87, P < 0.01). Cmpared with SAI, a high level of face validity in VAS of 76% was accepted.The mean SAI score was significantly lower in G group than in F group (36.13 + 3.04 versus 39.53 + 5.45, t = 2.11, P = 0.04) . This was also observed on the mean VAS score (6.63+4.52 versus 11.33 + 3.99, t - 3.02, P = 0.01). In contrast to the fasted patients, the drink-treating group showed greatly decreasing trends for...
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