Kotfis Katarzyna, Wojciechowska Arleta, Zimny Małgorzata, Jamioł-Milc Dominika, Szylińska Aleksandra, Kwiatkowski Sebastian, Kaim Karolina, Dołęgowska Barbara, Stachowska Ewa, Zukowski Maciej, Pankowiak Maria, Torbé Andrzej, Wischmeyer Paul
Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland.
Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland.
J Clin Med. 2023 Jul 28;12(15):4978. doi: 10.3390/jcm12154978.
Preoperative fasting and surgery cause metabolic stress, insulin resistance with ketosis, and postoperative nausea and vomiting (PONV). Oral carbohydrate loading strategy (CHO) improves outcomes in labor and general surgery. We aimed to compare the effectiveness of CHO with standard fasting in patients undergoing elective cesarean delivery (CD) under spinal anesthesia.
A single-center, parallel, prospective randomized controlled trial (RCT) was conducted in a tertiary university obstetrics department at Pomeranian Medical University in Szczecin, Poland. Patients were randomly assigned (1:1 ratio) to the CHO group (oral carbohydrate 2 h before elective CD, = 75) or the SF group (control-standard fasting, = 73). The main outcome measures were incidence and severity of PONV at 6 and 24 h after CD, time to the first peristalsis, time to first bowel movement, and biochemical parameters indicating ketosis in mothers and their children.
A total of 148 adult females with singleton pregnancies undergoing elective CD under spinal anesthesia (ASA I and II) were included in the final analysis. At 24 h after CD, 8.0% from the CHO group vs. 20.55% reported three or more episodes of vomiting or dry retching as compared to patients in the SF group ( = 0.041). Preoperative CHO supplementation decreased preoperative feelings of hunger ( < 0.001) and thirst ( < 0.001). Laboratory results in the CHO group showed higher plasma pH ( = 0.001) and glucose ( < 0.001), lower F2-isoprostane in plasma ( = 0.049) and urine ( = 0.018), lower urine F2-isoprostane/creatinine ratio ( = 0.045) than in the SF group. HOMA-IR ( < 0.001) and lactate ( < 0.001) were higher in the CHO group than in the control group.
There was no significant difference in the incidence or severity of early PONV at 6 h. The incidence of vomiting or dry retching at 24 h after cesarean delivery was lower in the CHO group as compared to standard starvation, but the combined results of PONV frequency and severity on the Wengritzky scale did not differ between the two study groups. Preoperative CHO supplementation decreased preoperative feelings of hunger and thirst, enhancing the comfort of pregnant women.
ClinicalTrials.gov identifier: NCT04069806.
术前禁食和手术会引发代谢应激、胰岛素抵抗伴酮症以及术后恶心呕吐（PONV）。口服碳水化合物负荷策略（CHO）可改善分娩和普通外科手术的结局。我们旨在比较CHO与标准禁食对接受脊髓麻醉下择期剖宫产（CD）患者的有效性。
在波兰什切青波美拉尼亚医科大学的一所三级大学产科进行了一项单中心、平行、前瞻性随机对照试验（RCT）。患者被随机分配（1:1比例）至CHO组（择期CD前2小时口服碳水化合物，n = 75）或SF组（对照 - 标准禁食，n = 73）。主要结局指标为CD后6小时和24小时PONV的发生率和严重程度、首次肠蠕动时间、首次排便时间以及指示母亲及其子女酮症的生化参数。
共有148例接受脊髓麻醉（ASA I和II）的单胎妊娠成年女性纳入最终分析。CD后24小时，CHO组8.0%的患者与SF组相比报告有三次或更多次呕吐或干呕发作（P = 0.041）。术前补充CHO降低了术前饥饿感（P < 0.001）和口渴感（P < 0.001）。CHO组的实验室结果显示血浆pH值更高（P = 0.001）、葡萄糖更高（P < 0.001），血浆（P = 0.049）和尿液（P = 0.018）中的F2 - 异前列腺素更低，尿液F2 - 异前列腺素/肌酐比值更低（P = 0.045），均低于SF组。CHO组的HOMA - IR（P < 0.001）和乳酸（P < 0.001）高于对照组。
6小时时早期PONV的发生率或严重程度无显著差异。与标准饥饿相比，CHO组剖宫产术后24小时呕吐或干呕的发生率更低，但两个研究组在Wengritzky量表上PONV频率和严重程度的综合结果无差异。术前补充CHO降低了术前饥饿感和口渴感，提高了孕妇的舒适度。
ClinicalTrials.gov标识符：NCT04069806。
