Preparation of Patients for Operation with Per-Oral Intake on the Day of the Planned Surgery
M. Kaška 1; T. Grosmanová 2; E. Havel 1; R. Hyšpler 3
Katedra chirurgie, LF v Hradci Králové, UK Praha, vedoucí: prof. MUDr. Z. Vobořil, DrSc.
1; IPCHO, FN Olomouc, primářka doc. MUDr. T. Grosmanová, CSc.
2; Klinika metabolická a gerontologická, FN Hradec Králové, přednosta: prof. MUDr. L. Sobotka, CSc.
Rozhl. Chir., 2006, roč. 85, č. 11, s. 554-559.
Monothematic special - Original
The clinical studies carried out leads to the hypothesis that the starvation of patients for several hours prior to a surgical procedure has a negative influence on the internal metabolic environment of a patient. It also has an impact on the psychosomatic disposition of the patient’s physiology of metabolic processes and the proper functioning of vital organs and systems. This hypothesis was already stated by doctors specialized in Intensive Care Units in other European countries. In the frame of methodology, ERAS (enhancement recovery after surgery) also known as fast track, solves this problem not only on the level of clinical studies but also clinical practice.
Methodology and group of patients:
The group of patients selected had been surgically treated for disease of the colon (both benign and malignant) and were divided into 3 groups: A – basically starving from mid-night of the day of operation, B – patients secured the night before the operation and on the day of the operation by a parenteral intake of 10% glucose solution with minerals, C – patients drinking a special drink, consisting basically of sugars (mainly maltodextrin) mixed in with minerals, the evening before the operation and on the day of the operation. Patients used in this study were required to fulfill several criteria to be included into the study: these criteria consisted of a co-morbidity of ASA 1–2, weight 60–90 kg, age 35–75 years, operating time of the procedure on the colon of 120 ± 30 min. without complications. These patients also had not been given any transfusions of red blood cells or blood derivatives during or after the surgery (or during the time of hospitalization etc). The selected biochemical markers, muscular power, some cardial function, and subjective patients feelings were monitored in all patients during perioperative period. The basic statistical methods were used for evaluation of current results.
The monitored parameters of the internal environment showed that the dynamics of the basic minerals had been roughly the same. The same scenario was found with serous concentrations of glucose, CRP, and albumin. In the group of patients given the sugar solution, there was a relative decrease in the serous concentration of insulin post-operatively (which is related to a lower insulin resistance) and serous concentration of myoglobin and creatin kinase. At the start of anesthesia, patient’s stomachs contained the lowest volume of residual liquid with a low pH in the group that was drinking the fluid on the day of the operation. The results of the measurements of muscular power (force) and echocardiograph have not been elaborated in detail so far. Unpleasant feelings in patients on the day of the operation like thirst, hunger, nervousness, fear, etc. were mainly reduced in the group of drinking patients.
Till date the findings documented by monitored indicators may prove that the implementation of per-oral intake on the day of an surgery will benefit and improve the quality of care of surgically treated patients and increase the number of successful operations.
preoperative care – preparation to surgery with drinking – fast track