scholarly journals The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials

Nutrients ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3105 ◽  
Author(s):  
Katarzyna Kotfis ◽  
Dominika Jamioł-Milc ◽  
Karolina Skonieczna-Żydecka ◽  
Marcin Folwarski ◽  
Ewa Stachowska
Keyword(s):  
Cardiac Surgery ◽  
Meta Analysis ◽  
Random Effect ◽  
Metabolic Stress ◽  
Insulin Requirement ◽  
Aortic Clamping ◽  
Icu Stay ◽  
Carbohydrate Loading ◽  
Inotropic Drugs ◽  
Preoperative Carbohydrate Loading

Background and aim: Preoperative fasting leads to metabolic stress and causes insulin resistance in patients undergoing cardiac surgery. The aim of this study was to assess the effect of preoperative oral carbohydrate loading (OCH) on outcome in patients undergoing planned cardiac surgery by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). Methods: Systematic search of PubMed/MEDLINE/Embase/Cinahl/Web of Science/ClinicalTrials databases was performed to identify relevant RCTs from databased inception until 05/03/2020. We included studies that compared outcome measures between OCH with control (placebo or standard starvation). We conducted a random-effect meta-analysis of clinical and biochemical parameters. Results: Nine studies (N = 9) were included with a total of 507 patients. OCH significantly decreased aortic clamping duration (n = 151, standardized mean difference (SMD) = −0.28, 95% confidence interval (CI) = −0.521 to −0.038, p = 0.023 and differences in means (DM) = −6.388, 95%CI = −11.246 to −1.529, p = 0.010). Patients from treatment groups had shorter intensive care unit (ICU) stay (n = 202, SMD = −0.542, 95%CI = −0.789 to −0.295, p < 0.001 and DM = −25.925, 95%CI = −44.568 to −7.283, p = 0.006) and required fewer units of insulin postoperatively (n = 85, SMD = −0.349, 95%CI = −0.653 to −0.044, p = 0.025 and DM = −4.523, 95%CI = −8.417 to −0.630, p = 0.023). The necessity to use inotropic drugs was significantly lower in the OCH group (risk ratio (RR) = 0.795, 95%CI = 0.689 to 0.919, p = 0.002). All other primary outcomes did not reveal a significant effect. Conclusions: Preoperative OCH in patients undergoing cardiac surgery demonstrated a 20% reduction in the use of inotropic drugs, a 50% reduction of the length of ICU stay, a 28% decrease in aortic clamping duration and a 35% decrease of postoperative insulin requirement.

scholarly journals Reply to: “Preoperative Carbohydrate Loading on Outcomes after Cardiac Surgery: A Flawed Meta-Analysis. Comment on: The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients 2020, 12, 3904”

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3905
Author(s):  
Katarzyna Kotfis ◽  
Dominika Jamioł-Milc ◽  
Karolina Skonieczna-Żydecka ◽  
Marcin Folwarski ◽  
Ewa Stachowska
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Carbohydrate Loading ◽  
Preoperative Carbohydrate Loading

We appreciate the thoughts and questions posed by Drs Dileep N Lobo and Girish P Joshi [...]

scholarly journals Erratum to: Preoperative carbohydrate loading for elective surgery: a systematic review and meta-analysis

Surgery Today ◽  
2012 ◽  
Vol 42 (11) ◽  
pp. 1142-1142
Author(s):  
Lun Li ◽  
Zehao Wang ◽  
Xiangji Ying ◽  
Jinhui Tian ◽  
Tiantian Sun ◽  
...  
Keyword(s):  
Systematic Review ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Carbohydrate Loading ◽  
Preoperative Carbohydrate Loading

Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery

2016 ◽  
Vol 104 (3) ◽  
pp. 187-197 ◽  
Author(s):  
M. A. Amer ◽  
M. D. Smith ◽  
G. P. Herbison ◽  
L. D. Plank ◽  
J. L. McCall
Keyword(s):  
Elective Surgery ◽  
Meta Analysis ◽  
Carbohydrate Loading ◽  
Preoperative Carbohydrate Loading

Preoperative carbohydrate loading for elective surgery: a systematic review and meta-analysis

Surgery Today ◽  
2012 ◽  
Vol 42 (7) ◽  
pp. 613-624 ◽  
Author(s):  
Lun Li ◽  
Zehao Wang ◽  
Xiangji Ying ◽  
Jinhui Tian ◽  
Tiantian Sun ◽  
...  
Keyword(s):  
Systematic Review ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Carbohydrate Loading ◽  
Preoperative Carbohydrate Loading

Abstract 16264: Ace-inhibitors and Vasoplegia in the Post Cabg Population/valvular Surgery Population: An Updated Systematic Review and Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Brice Nouthe ◽  
Christian Ngongang Ouankou ◽  
Marco Spaziano ◽  
yin T sia
Keyword(s):  
Renal Failure ◽  
Cardiac Surgery ◽  
Risk Factor ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Valve Surgery ◽  
Valvular Surgery ◽  
Full Text Review ◽  
Distributive Shock

Introduction: Chronic use of ACE-i has been presented as a risk factor of post operative vasoplegia after cardiac surgery. However, a recent meta analysis of studies in the general cardiac surgery population identified renal failure as the only pre-operative risk factor for vasoplegia. We sought to systematically review the relationship of chronic ACE-i and vasoplegia in patients undergoing CABG /valve surgery. Hypothesis: Studies on vasoplegia after CABG / valve surgery were extracted by a research librarian (registered review CRD42017072923) before bias and quality of studies were assessed. We adjudicated vasoplegia as MAP < 60 mmHg and use of at least one non dopaminergic vasoactive drug up to 4 hours post operatively. Otherwise, studies reported vasoplegia as MAP < 60 mmHg, CI > 2.5 l/min/m2 and SVR < 600 dynes/sec/cm2 in the CSICU. We pooled the incidence of vasoplegia then completed a meta-analysis with random effect model using RevMan and Stata. Methods: Of the 2337 articles obtained (1940 non relevant, 22 reviews, 5 duplicates and 5 editorials), we pre-selected 365 abstracts and summarized data from 8,818 patients out of 7 articles selected after full text review. Results: All but one study looked at patients with LVEF > 40%. The pooled incidence of vasoplegia was 11.2% (95% CI 4.7-28.2). The OR of vasoplegia in patients on chronic ACE-i was 1.74 (95% CI: 1.47-2.06). We could not investigate the importance of pre-existing renal failure on the risk of post operative vasoplegia in patients on ACE-i. Accounting for substantial heterogeneity, the Egger test was in favour of small-study effects due to the number of cases of vasoplegia and the size of the cohorts studied (p=0.073). Conclusions: The risk of vasoplegia seems to be higher in patients on ACE-i undergoing CABG/valve surgery in this population. Two RCT's (161 patients) did not prove the benefit of temporary discontinuation of RAS blockade on the incidence of distributive shock during the first days after surgery. Because ACE-i are frequently prescribed in patients awaiting CABG, our work calls for larger and more elaborated studies to reduce the risk of vasoplegia.

Meta-Analysis of Electroacupuncture in Cardiac Anesthesia and Intensive Care

2017 ◽  
Vol 34 (8) ◽  
pp. 652-661 ◽  
Author(s):  
Sven Asmussen ◽  
Rene Przkora ◽  
Dirk M. Maybauer ◽  
John F. Fraser ◽  
Filippo Sanfilippo ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Troponin I ◽  
Meta Analysis ◽  
Open Heart Surgery ◽  
Cochrane Library ◽  
Vasoactive Drugs ◽  
Icu Stay ◽  
Anesthetic Drugs ◽  
Postoperative Dose

Background: Acupuncture treatment has been employed in China for over 2500 years and it is used worldwide as analgesia in acute and chronic pain. Acupuncture is also used in general anesthesia (GA). The aim of this systematic review and meta-analysis was to assess the efficacy of electroacupuncture (EA) in addition to GA in patients undergoing cardiac surgery. Methods: We searched 3 databases (Pubmed, Cochrane Library, and Web of Science—from 1965 until January 31, 2017) for randomized controlled trials (RCTs) including patients undergoing cardiac surgery and receiving GA alone or GA + EA. As primary outcomes, we investigated the association between GA + EA approach and the dosage of intraoperative anesthetic drugs administered, the duration of mechanical ventilation (MV), the postoperative dose of vasoactive drugs, the length of intensive care unit (ICU) and hospital stay, and the levels of troponin I and cytokines. Results: The initial search yielded 477 citations, but only 7 prospective RCTs enrolling a total of 321 patients were included. The use of GA + EA reduced the dosage of intraoperative anesthetic drugs ( P < .05), leading to shorter MV time ( P < .01) and ICU stay ( P < .05) as well as reduced postoperative dose of vasoactive drugs ( P < .001). In addition, significantly lower levels of troponin I ( P < .01) and tumor necrosis factor α ( P < .01) were observed. Conclusion: The complementary use of EA for open-heart surgery reduces the duration of MV and ICU stay, blunts the inflammatory response, and might have protective effects on the heart. Our findings stimulate future RCT to provide definitive recommendations.

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