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The effects of oral preoperative carbohydrates administration on postoperative outcome

تأثير اعطاء المحاليل السكرية الفموية قبل العمل الجراحي على حدوث المضاعفات التالية للعمل الجراحي

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 Publication date 2016
  fields Nursing
and research's language is العربية
 Created by Shamra Editor




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Introduction: Ileus commonly occurs after abdominal surgery, and is associated with complications and increased length of hospital stay (LOHS). Traditionally, preoperative practice has been to fast the patient for up to 12 h prior to surgery. The rationale for this is to reduce gastric acidity and volume with a consequent decrease in the risk of gastric content aspiration during surgery. However, A Cochrane review found no increased risk of aspiration in patients who were allowed fluids 2–3 h prior to surgery compared to patients having undergone a traditional fasting period .. A carbohydrate-rich beverage given before anaesthesia and surgery alters metabolism from the overnight fasted to the fed state. This reduces the catabolic response (insulin resistance) after operation, which may have implications for postoperative recovery. Aim : to investigates the effect of preoperative carbohydrate treatment on postoperative ileus in adult patients undergoing abdominal surgery. Material and methods: fifty abdominal surgery patients were randomly assigned to preparation with a 12.5% carbohydrate drink (CHO) (25), or overnight fasting group (25). The CHO group were given 600 mL to drink on the evening before and 400 mL on the morning of surgery. The patients' complains of nausea and vomiting was noted, the length hospital stay and the duration of postoperative ileus (POI), was measured in tow groups. Conclusions: This study showed that pre-operative carbohydrate drink may be used safely and also improves patient's comfort as decrease rate of nausea and vomiting and reduce the length of hospital stay in patients undergoing abdominal surgery.


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Research summary
تتناول الدراسة تأثير إعطاء المحاليل السكرية الفموية قبل العمليات الجراحية على حدوث المضاعفات التالية للعمل الجراحي. الشلل المعوي يعد من المضاعفات الشائعة بعد العمليات الجراحية البطنية، مما يؤدي إلى زيادة فترة بقاء المريض في المستشفى. تقليديًا، يُطلب من المرضى الصيام لمدة تصل إلى 12 ساعة قبل الجراحة لتقليل حجم وحموضة المعدة، وبالتالي تقليل خطر الاستنشاق الرئوي. ومع ذلك، أظهرت الدراسات الحديثة أن تناول السوائل قبل 2-3 ساعات من الجراحة لا يزيد من خطر الاستنشاق الرئوي. تهدف الدراسة إلى تحديد تأثير إعطاء المحاليل السكرية الفموية على حدوث المضاعفات بعد الجراحة. تم تطبيق الدراسة على 50 مريضًا خضعوا لعمليات جراحية بطنية تحت التخدير العام، وتم تقسيمهم إلى مجموعتين: مجموعة تجريبية تلقت محاليل سكرية ومجموعة ضابطة اتبعت سياسة الصيام التقليدي. أظهرت النتائج أن إعطاء المحاليل السكرية يقلل من زمن عودة الحركات الحوية، ويقلل من حدوث الغثيان والقيء، ويقلل من مدة بقاء المريض في المستشفى.
Critical review
دراسة نقدية: تعتبر هذه الدراسة خطوة مهمة نحو تحسين الرعاية الجراحية وتقليل المضاعفات بعد العمليات الجراحية. ومع ذلك، هناك بعض النقاط التي يمكن تحسينها. أولاً، حجم العينة صغير نسبيًا (50 مريضًا فقط)، مما قد يؤثر على قوة النتائج وإمكانية تعميمها. ثانيًا، لم يتم توضيح ما إذا كانت هناك اختلافات في نوع العمليات الجراحية التي خضع لها المرضى، مما قد يؤثر على النتائج. ثالثًا، لم يتم تناول تأثير المحاليل السكرية على المرضى الذين يعانون من حالات طبية معينة مثل السكري. وأخيرًا، يُفضل إجراء دراسات مستقبلية تشمل عينات أكبر وتنوعًا أكبر في نوع العمليات الجراحية والمرضى لتأكيد النتائج وتوسيع نطاق التوصيات.
Questions related to the research
  1. ما هو الهدف الرئيسي من الدراسة؟

    الهدف الرئيسي من الدراسة هو تحديد تأثير إعطاء المحاليل السكرية الفموية قبل العمل الجراحي على حدوث المضاعفات التالية للعمل الجراحي.

  2. ما هي الفروقات بين المجموعة التجريبية والمجموعة الضابطة في الدراسة؟

    المجموعة التجريبية تلقت محاليل سكرية قبل الجراحة، بينما اتبعت المجموعة الضابطة سياسة الصيام التقليدي. أظهرت النتائج أن المجموعة التجريبية كانت لديها عودة أسرع للحركات الحوية، وقلّت لديها نسبة حدوث الغثيان والقيء، وكانت مدة بقاءهم في المستشفى أقل مقارنة بالمجموعة الضابطة.

  3. ما هي النتائج الرئيسية التي توصلت إليها الدراسة؟

    النتائج الرئيسية هي أن إعطاء المحاليل السكرية الفموية قبل الجراحة يقلل من زمن عودة الحركات الحوية، ويقلل من حدوث الغثيان والقيء، ويقلل من مدة بقاء المريض في المستشفى.

  4. ما هي التوصيات التي قدمتها الدراسة بناءً على النتائج؟

    توصي الدراسة باعتماد سياسة إعطاء المرضى الذين سيخضعون لعمل جراحي محاليل سكرية صافية سوية التوتر (12.5%) قبل الجراحة بثلاث ساعات، لما لها من فوائد في تسريع زمن عودة الحركات الحوية وتخفيف درجة الغثيان والقيء، مما ينعكس على تقليل مدة بقاء المريض في المستشفى.


References used
SHORT V1, HERBERT G, PERRY R, ATKINSON C, NESS AR, PENFOLD C, THOMAS S, ANDERSEN HK, LEWIS SJ. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev. 2015 Feb 20;2
KEHLET H, MOGENSEN T. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation program. Br J Surg. 1999 Feb;86(2):227-30
SENAGORE AJ1. Pathogenesis and clinical and economic consequences of postoperative ileus. Am J HEALTH Syst Pharm. 2007 Oct 15;64(20 Suppl 13):S3-7
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Introduction: Ileus commonly occurs after abdominal surgery, and is associated with complications and increased length of hospital stay. Post-operative ileus (POI) is an important reason for remaining patients not permit oral (NPO) in post-operativ e period. The tradition was that when patients passed flatus, they were ready to consume a liquid diet, and then a solid food diet was gradually introduced. This approach was taken to avoid aspiration, gastric and intestinal distension, and anastomotic dehiscence. Although studies demonstrated that the conventional strict feeding regimens were not necessary, many surgeons still hesitated to allow early oral feeding. There has been concern that early oral intake would result in vomiting and severe paralytic ileus with subsequent aspiration pneumonia, wound dehiscence and anastomotic leakage. This belief has become surgical dogma, unsupported by scientific evidence. Aim: to investigates the effect of early oral postoperative carbohydrates feeding on postoperative outcome. Material and methods: forty abdominal surgery patients were randomly assigned to early oral postoperative feeding group (20) or traditional feeding group (20). In the early feeding group (study group), patients were initially started on clear fluid only 16 h after surgery and progressed to liquids (after 24 h) and then soft and regular diet in next day (after 48 h). In the post-operative period, the patients were visited each 12 h and clinical signs and symptoms such as, time of passed flatus and moved their bowels, nausea and vomiting, and the length hospital stay were assessed. Conclusions: This study showed that early oral postoperative carbohydrates feeding group passed flatus and moved their bowels much sooner than the control group thus reducing the duration of POI and hospital stay, but there is no increase in occurrence of of nausea and vomiting between tow groups.
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