Effect of the abbreviation of preoperative fasting to 2h with a drink containing carbohydrate in postoperative pulmonary function after Thoracoscopic Sympathectomy: a pilot randomized study: Efeito da abreviação do tempo de jejum pré-operatório para 2h com bebida contendo carboidratos na função pulmonar após a Simpatectomia Toracoscopica: um estudo piloto randomizado

Objective: The organic response to trauma is attenuated by intake of a carbohydrate (CHO)-enriched drink 2 hours before surgery, as opposed to strict preoperative fasting. We investigated whether this approach would improve postoperative respiratory function in patients undergoing bilateral thoracoscopic sympathectomy. Method: Qualifying patients (mean age, 24 years; range, 16-37 year) scheduled for thoracoscopic sympathectomy were randomized to conventional 6- to 8-hour fasting (control group, n=7) or 6-hour fasting for solids, followed by intake of a CHO-rich drink (12% maltodextrin in 200 mL of water) 2 hours before anesthesia (CHO group, n=7). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and forced expiratory flow between 25% and 75% of FVC (FEF 25-75%) were measured, and cirtometry was performed pre- and postoperatively (Day 1). The visual analog scale (VAS) was used to assess pain and well-being postoperatively. Results: Pain and well-being did not differ between groups by VAS scores. Thoracic expansibility declined postoperatively in both groups at axillary level but significantly decreased at xiphoid level only in the control group (p=0.04). Both groups showed significant declines in FVC and FEV1 on postoperative Day 1. Only the control group displayed significant postoperative FEF 25-75% decline, compared with preoperative baseline (p=0.01). Conclusion: In this pilot study, intake of a CHO-enriched drink 2 hours preoperatively benefitted patients postoperatively, enhancing basilar lung expansion and marginally improving lung function

Probiotics enhance the recovery of gut atrophy in experimental malnutrition

ABSTRACT: AIM: The aim of this study was to evaluate the effect of probiotics on the recovery of the bowel atrophy induced by malnutrition in rats. METHODS: Twenty-and-six Wistar rats (200-250g) were fed with either a normoproteic (sham group, n=6) or a free-protein diet (n=20) during 12 days. Twelve malnourished rats were randomized to recover during 15 days with either a hydrolyzed diet (control group, n=6) or the same diet enriched with probiotics (Streptococcus thermophilus and Lactobacillus helveticus; probiotic group, n=6). RESULTS: Probiotic group showed similar gain of body, liver and bowel weight than controls. At the jejunum, both the villus height (383±49 vs. 321±46mm; p=0.04) and crypt depth (157±31 vs. 125±10mm; p=0.04) were greater in probiotic group than in controls. The crypt depth at the cecum (214±22 vs. 169±43 mm; p=0.05) and the wall width at both the cecum (410±18 vs. 340±61 mm; p=0.02) and sigmoid (479±130 vs. 330±62 mm; p=0.03) were higher in probiotic than in control group. CONCLUSION: Streptococcus thermophilus and Lactobacillus helveticus enhance the recovery of gut atrophy induced by malnutrition. Probiotics can be useful as oral adjuvants during the recovery of malnutrition

Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial

<p>Abstract</p> <p>Background</p> <p>Prolonged preoperative fasting increases insulin resistance and current evidence recommends carbohydrate (CHO) drinks 2 hours before surgery. Our hypothesis is that the addition of whey protein to a CHO-based drink not only reduces the inflammatory response but also diminish insulin resistance.</p> <p>Methods</p> <p>Seventeen patients scheduled to cholecystectomy or inguinal herniorraphy were randomized and given 474 ml and 237 ml of water (CO group) or a drink containing CHO and milk whey protein (CHO-P group) respectively, 6 and 3 hours before operation. Blood samples were collected before surgery and 24 hours afterwards for biochemical assays. The endpoints of the study were the insulin resistance (IR), the prognostic inflammatory and nutritional index (PINI) and the C-reactive protein (CRP)/albumin ratio. A 5% level for significance was established.</p> <p>Results</p> <p>There were no anesthetic or postoperative complications. The post-operative IR was lower in the CHO-P group when compared with the CO group (2.75 ± 0.72 vs 5.74 ± 1.16; p = 0.03). There was no difference between the two groups in relation to the PINI. The CHO-P group showed a decrease in the both CRP elevation and CRP/albumin ratio (p < 0.05). The proportion of patients who showed CRP/albumin ratio considered normal was significantly greater (p < 0.05) in the CHO-P group (87.5%) than in the CO group (33.3%).</p> <p>Conclusions</p> <p>Shortening the pre-operative fasting using CHO and whey protein is safe and reduces insulin resistance and postoperative acute phase response in elective moderate operations.</p> <p>Trial registration</p> <p>ClinicalTrail.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01354249">NCT01354249</a></p