Effects Of Preoperative Carbohydrate Consumption On Gastric Volu Me Before Anesthesia And Postoperative Insulin Resistance In Elder Ly Patients With High-risk Surgery

Abstract:Objective:Using bedside ultrasound to observe the effect of carbohydrate consumption 2 hours before surgery on gastric volume in elderly patients with high-risk surgery,and further observe the effect on postoperative insulin resistance.Methods:November 2017 to October 2018 in sichuan province people's hospital undergoing elective open abdomen high-risk operation?radical gastrectomy and Colorectal surgery?patients with 70 cases,65-85 years old,ASA grading?or?,were elected.All patients are randomly divided into two groups,experimental group of 34 cases and control group 36 cases by the computer random number sequence table.Experimental group was fasted for 8 hours and drunk 200ml carbohydrate?operative energy,yichang renfu?2 hours before surgery.Control group was fasted for 8 hours and prohibited drinking for 4 hours before surgery according to the requirements of conventional preoperative fasting and prohibition of drinking.Gastric tube was not placed in the two groups of patients before anesthesia induction.If required,placed gastric tube after tracheal intubation under general anesthesia.The experiment was divided into two steps.1.The gastric volume of the two groups was evaluated before anesthesia induction by ultrasound technology.After the patient entered the anesthesia preparation room,the gastric volume was assessed by a qualified professional anesthesiologist A,who trained by bedside gastric ultrasound technology.The anesthesiologist did not know the patient's group.The gastric antrum of every patient was scanned in the order of supine position,Semi sitting position of 45°and right lateral decubitus and made a qualitative and semi-quantitative assessment.The anteroposterior diameter?D1?and craniocaudal diameter?D2?of the gastric antrum were measured in accordance with the standard method of measurement with Semi sitting position and right lateral decubitus.The distal cross-sectional area?cross-sectional area,CSA?of the two positions were calculated according to the formula,noted as CSA₁,CSA₂ respectively;The gastric volume?GV?of the two groups were further calculated,noted as GV₁ and GV_2,based on the formula of gastric volume under semi-sitting position and right lateral decubitus.The gastric volume/weight?GV/weight,GV/W?were calculated,noted as GV₁/W,GV₂/W.The risk of reflux aspiration were assessed.2.Observing the difference of postoperative insulin resistance between the two groups.All patients were admitted to go to the operating room for preoperative preparation,if assessed to have a low risk of reflux aspiration.The anesthesiologist B,who did not know the people,s group,gave all patients visual analogue scale?VAS?for their sense of thirst and anxiety.Electrocardiogram,blood pressure,pulse oxygen saturation and anesthesia depth index were routinely monitored.The anesthesia,intraoperative management,postoperative analgesia and postoperative nausea and vomiting prevention and treatment were consistent in the two groups.Blood glucose and Insulin levels of the two groups were measured at each time point of fasting one day before surgery?T₁?,before anesthesia induction?T₂?,1h after surgery?T₃?,and immediately after surgery?T₄?,and one day after surgery?T₅?.Insulin resistance index?IR?was calculated according to homeostasis modle assessment?HOMA?.Results:1.There are no statistically significant differences between the two groups in gender ratio,age,height,weight,BMI,surgical category,and ASA classification?p>0.05?.2.In the semi-sitting position,there was no statistical difference in CSA₁ and GV₁between the two groups?p>0.05?,and GV₁/W of the experimental group was greater than that of the control group,with statistically significant differences?p<0.05?.In the right lateral decubitus,CSA₂,GV₂ and GV₂/W of the experimental group were larger than those of the control group?CSA₂,GV₂ and GV₂/W?,with statistically significant differences?p<0.05?.Intra-group comparison showed that CSA₂ in the experimental group was larger than CSA₁,with statistically significant differences?p<0.05?,and GV₁ in the experimental group was larger than GV₂,with statistically significant differences?p<0.05?.CSA₂ in the control group was larger than CSA₁,and the results were statistically different?p<0.05?.The patients in the control group had greater GV₁ than GV₂,and the results were statistically different?p<0.05?.3.There was no significant difference in the proportion of semi-quantitative score and the proportion of reflux aspiration risk grading between the two groups?p>0.05?.4.The VAS score of the patients in the experimental group before anesthesia induction was lower than that in the control group,with statistically significant difference?p<0.05?.Compared with the scores of anxiety,the results showed no statistical difference?p>0.05?.5.There were no statistically significant differences between the two groups in anesthesia time,operation time,intraoperative blood loss,intraoperative infusion volume and urine volume?p>0.05?.6.The postoperative IR of the experimental group was lower than that of the control group,with statistically significant difference?p<0.05?.7.The postoperative exhaust time of patients in the experimental group was earlier than that of the control group,with statistically significant difference?p<0.05?.There was no significant difference in postoperative complications and postoperative hospital stay between the two groups?p>0.05?.Conclusions:1.Preoperative carbohydrate consumption did not increase preanesthesia gastric volume in elderly patients with high-risk surgery,nor increase the risk of reflux aspiration.2.Preoperative consumption of carbohydrates can significantly reduce the thirst of elderly patients with high-risk surgery before anesthesia.3.Preoperative consumption of carbohydrates can reduce the postoperative insulin resistance in elderly patients with high-risk surgery.