Sharma Ankita, Singh Udeyana, Kaur Gurpreeti, Grewal Anju, Maingi Sahil, Tidyal Swati
Dayanand Medical College, Ludhiana, Punjab, India.
All India Institute of Medical Sciences Bathinda, Punjab, India.
J Anaesthesiol Clin Pharmacol. 2024 Jul-Sep;40(3):439-444. doi: 10.4103/joacp.joacp_172_23. Epub 2024 Feb 8.
Starvation of long duration during third trimester of pregnancy is undesirable as it is associated with accelerated fasting leading to hypoglycemia, raised plasma free fatty acid (FFA) levels, and increased plasma/urinary ketones. Carbohydrate (CHO)-rich drinks given preoperatively may ameliorate these deleterious effects. The enhanced recovery after surgery (ERAS) guidelines for perioperative care recommend that oral CHO fluid supplementation 2 h before cesarean delivery may be offered to nondiabetic pregnant women. The aim of the study was to evaluate the role of preoperative oral CHO loading for the prevention of perioperative ketoacidosis in elective cesarean deliveries.
One hundred and twenty American Society of Anesthesiologists (ASA) II/III parturients undergoing elective cesarean section under subarachnoid block (SAB) were divided into two groups of 60 each after they gave written informed consent. Group A parturients received 400 ml of filtered water 2 h before surgery. Group B parturients received 400 ml of nonparticulate CHO drink 2 h before surgery. The primary outcome was the incidence of ketonuria studied by the dipstick method. Secondary outcomes included hunger and thirst scores, anxiety score, dominant hand grip strength, and the quality of recovery score.
The urine ketone levels were positive (+1) in 8.3% parturients in group A and 1.7% parturients in the CHO group ( value- 0.094). The hunger and thirst scores as well as the modified Beck's anxiety scores were significantly lower in the CHO group ( value- 0.002). Dominant hand grip strength was preserved in both the groups ( value- 0.827). The quality of recovery score was significantly improved in the CHO group ( value- 0.002). No serious adverse effects were noted in either group.
Oral CHO drink is safe when administered 2 h before uncomplicated elective cesarean deliveries. It may have a positive influence on a wide range of perioperative markers of clinical outcome.
妊娠晚期长时间饥饿是不可取的，因为这与空腹加速导致低血糖、血浆游离脂肪酸（FFA）水平升高以及血浆/尿酮增加有关。术前给予富含碳水化合物（CHO）的饮料可能会改善这些有害影响。围手术期护理的加速康复外科（ERAS）指南建议，对于非糖尿病孕妇，可在剖宫产术前2小时提供口服CHO液体补充剂。本研究的目的是评估术前口服CHO负荷在择期剖宫产中预防围手术期酮症酸中毒的作用。
120例美国麻醉医师协会（ASA）II/III级产妇在签署书面知情同意书后，接受蛛网膜下腔阻滞（SAB）下的择期剖宫产手术，分为两组，每组60例。A组产妇在手术前2小时接受400毫升过滤水。B组产妇在手术前2小时接受400毫升非颗粒状CHO饮料。主要结局是通过试纸法研究的酮尿症发生率。次要结局包括饥饿和口渴评分、焦虑评分、优势手握力以及恢复质量评分。
A组8.3%的产妇尿酮水平呈阳性（+1），CHO组为1.7%（ 值-0.094）。CHO组的饥饿和口渴评分以及改良贝克焦虑评分显著更低（ 值-0.002）。两组的优势手握力均得以保留（ 值-0.827）。CHO组的恢复质量评分显著改善（ 值-0.002）。两组均未观察到严重不良反应。
在无并发症的择期剖宫产术前2小时给予口服CHO饮料是安全的。它可能对广泛的围手术期临床结局指标产生积极影响。
