1.
Preoperative Carbohydrate Loading in Gynecological Patients Undergoing Combined Spinal and Epidural Anesthesia.
Zhang, Y, Min, J
Journal of investigative surgery : the official journal of the Academy of Surgical Research. 2020;(7):587-595
Abstract
Purpose: Preoperative carbohydrate loading (CHO) could improve insulin sensitivity and promoted postoperative recovery under general anesthesia. The aim of this study was to investigate the effects of CHO on gynecological patients. Methods: A group of 58 female patients undergoing surgery were randomized to either fast overnight (the FAST group) or receive 800 ml of CHO the evening before and 400 ml 2 h before anesthesia (the CHO group).The perioperative well-being and the nutritional status, as determined by blood samples for three biochemical assays (the base status, the status after the operation, and the status on the first day after the operation), were recorded. The homeostasis model assessment (HOMA-IR) was used to measure perioperative insulin resistance. The primary endpoint was phantom limb syndrome (PLS) induced by combined spinal and epidural anesthesia (CSEA). Results: The CHO group had significantly lower levels of anxiety (p < 0.01), hunger (p < 0.01), and thirst (p < 0.01); lower incidence of PLS (p < 0.01) and abdominal distention (p < 0.05); earlier occurrence of first flatus (p < 0.01); and fewer hospitalization days (p < 0.01) than patients from the FAST group. Biochemical analysis showed that the levels of interleukin-6 (IL-6) (p < 0.01), C-reactive protein (p < 0.01), cortisol (p < 0.01), glucose (p < 0.01), insulin (p < 0.01), and HOMA-IR (p < 0.01) were lower in the CHO patients. Lactate, pyruvate, and lactate/pyruvate ratios for the CHO patients were also lower than those for the FAST patients. Conclusions: CHO increased perioperative comfort in gynecological patients undergoing CSEA. It also attenuated insulin resistance after the operation and reduced the number of postoperative stress reactions.
2.
A randomized controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing elective craniotomy.
Liu, B, Wang, Y, Liu, S, Zhao, T, Zhao, B, Jiang, X, Ye, L, Zhao, L, Lv, W, Zhang, Y, et al
Clinical nutrition (Edinburgh, Scotland). 2019;(5):2106-2112
Abstract
OBJECT The aim of this study was to evaluate the effect of preoperative oral carbohydrate loading versus fasting on the outcomes of patients undergoing elective craniotomy. METHODS In a single-center randomized controlled study, 120 neurosurgical patients who were admitted for elective craniotomy were included and randomized into 2 groups: 58 patients received 400 mL of oral carbohydrate loading 2 h before surgery (intervention group), and 62 patients were fasting for 8 h prior to surgery as routine management (control group). The primary end point was glucose homeostasis. Secondary outcomes included handgrip strength, pulmonary function and postoperative complications. RESULTS Better glucose homeostasis (5.6 ± 1.0 mmol/L vs. 6.3 ± 1.2 mmol/L, P = 0.001) was achieved in patients who received preoperative oral carbohydrate loading compared to fasting. Furthermore, patients in the intervention group had better handgrip strength (25.3 ± 7.1 kg vs. 19.9 ± 7.5 kg, P < 0.0001) and pulmonary function (in terms of peak expiratory flow rate) (315.8 ± 91.5 L/min vs. 270.0 ± 102.7 L/min, P = 0.036) compared to the controls postoperatively. The rates of postoperative surgical and non-surgical complications did not differ between the groups. Both postoperative and total hospital length of stay (LOS) reduced significantly in the intervention group (-3d, P < 0.0001 and P = 0.004). CONCLUSIONS Oral carbohydrate loading given 2 h before surgery in patients undergoing elective craniotomy seems to improve glucose homeostasis, handgrip strength and pulmonary function as well as decrease LOS without increasing the risk of postoperative complications. Routine use of preoperative oral carbohydrate loading could be suggested in clinical settings, though further evaluation of its safety and efficacy is warranted.
3.
The clinical utility of QSM: disease diagnosis, medical management, and surgical planning.
Eskreis-Winkler, S, Zhang, Y, Zhang, J, Liu, Z, Dimov, A, Gupta, A, Wang, Y
NMR in biomedicine. 2017;(4)
Abstract
Quantitative susceptibility mapping (QSM) is an MR technique that depicts and quantifies magnetic susceptibility sources. Mapping iron, the dominant susceptibility source in the brain, has many important clinical applications. Herein, we review QSM applications in the diagnosis, medical management, and surgical treatment of disease. To assist in early disease diagnosis, QSM can identify elevated iron levels in the motor cortex of amyotrophic lateral sclerosis patients, in the substantia nigra of Parkinson's disease (PD) patients, in the globus pallidus, putamen, and caudate of Huntington's disease patients, and in the basal ganglia of Wilson's disease patients. Additionally, QSM can distinguish between hemorrhage and calcification, which could prove useful in tumor subclassification, and can measure microbleeds in traumatic brain injury patients. In guiding medical management, QSM can be used to monitor iron chelation therapy in PD patients, to monitor smoldering inflammation of multiple sclerosis (MS) lesions after the blood-brain barrier (BBB) seals, to monitor active inflammation of MS lesions before the BBB seals without using gadolinium, and to monitor hematoma volume in intracerebral hemorrhage. QSM can also guide neurosurgical treatment. Neurosurgeons require accurate depiction of the subthalamic nucleus, a tiny deep gray matter nucleus, prior to inserting deep brain stimulation electrodes into the brains of PD patients. QSM is arguably the best imaging tool for depiction of the subthalamic nucleus. Finally, we discuss future directions, including bone QSM, cardiac QSM, and using QSM to map cerebral metabolic rate of oxygen. Copyright © 2016 John Wiley & Sons, Ltd.