Browsing by Author "Kriel, Janine"
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- ItemPreoperative oral carbohydrate treatment to prevent perioperative complications in adults : a systematic review of the evidence(Stellenbosch : Stellenbosch University, 2017-03) Kriel, Janine; Visser, Janicke; Blaauw, Renee; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Background: Preoperative standard fasting is associated with deleterious effects with consequent negative clinical outcomes. Preoperative oral carbohydrate loading (POCL) is considered a safe alternative to fasting, and recommended by numerous anaesthesia societies worldwide. The evidence supporting this intervention is increasing and pooling of data is required to promote clinical relevance. Objectives: To systematically review the effect of POCL on perioperative complications and well-being in adult patients undergoing elective surgery. Search strategy: Electronic databases, article reference lists and personal files were searched from inception up to May 2015. Selection criteria: Randomised controlled trials (RCTs) of POCL compared with other preoperative regimens in adult patients undergoing elective surgery. The experimental group had to receive at least 45 g of carbohydrates with an osmolality of less than 300 mOsm/kg within three hours before surgery. Data collection and analysis: Details of the eligible studies were extracted by the principal investigator and independent reviewer. Authors were contacted to obtain missing information. Methodological quality was assessed according to methodology described by The Cochrane Collaboration. Results: Twenty four RCTs involving 1 903 participants were identified for inclusion. The majority of the trials were conducted in developed and emerging countries and were based on otherwise healthy adult participants who were not considered to be at increased risk of regurgitation or aspiration. The quality of the evidence was moderate to low, hence the high risk of bias. Due to the heterogeneity of trials and the small number of included trials per comparison, limited data could be pooled for inclusion in a meta-analysis. Twenty-three trials including 1 841 participants reported on the primary outcomes. The immune status (in terms of C-reactive protein levels) of patients receiving POCL was better preserved compared to those in the standard fasting group (p = 0.006). No significant evidence of effect for POCL was demonstrated for any other clinical outcomes. Adverse events in terms of regurgitation, aspiration, morbidity and mortality were either not reported to occur or were not investigated in the included trials. As reported by 16 trials involving 1449 participants, the well-being of patients receiving POCL was improved or at least maintained in most of the trials. Conclusion: POCL is a safe alternative to standard fasting with no associated adverse events. There is not enough evidence to draw conclusions with absolute certainty on the clinical outcomes. However, there is a trend that POCL improves the well-being of surgical patients. Therefore, the potential benefits of POCL need to be balanced against the cost as well as patient preference. Emphasis should be on the type of surgery performed as well as the effect of minor versus major surgery on outcomes. Keep in mind that POCL is time (up to two hours before surgery), dose (at least 45 g carbohydrates) and patient (otherwise healthy elective surgery patients) specific. POCL should be perceived as a single element of enhanced recovery and the combination of different elements might produce more beneficial results than a single element by itself.