Comparative Study between Traditional Fasting versus Overnight Infusion of Lipid or Carbohydrate on Inotropic Support in Obese Patients Undergoing Elective On-Pump Coronary Artery Bypass Grafting
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- Category: Vol. 85, September 2017
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Comparative Study between Traditional Fasting versus Overnight Infusion of Lipid or Carbohydrate on Inotropic Support in Obese Patients Undergoing Elective On-Pump Coronary Artery Bypass Grafting, MOHAMED AHMAD M. IBRAHIM, WAEL EL-SIOORY, HISHAM HOSNY, AMR ABD EL-MONEM and NORMEEN H. RADY
Abstract
Introduction: The metabolic consequences of overnight fasting come from low insulin level and high glucagon, which are responsible for glycogenolysis, gluconeogesis, lipolysis, and finally proteolysis. This fast milieu stands for the stress response that signifies fasting before surgeries. We compared the effects of preoperative fasting with pre-operative infusion of lipid emulsion or carbohydrate on inotropic support in obese patients undergoing elective on-pump coronary artery bypass grafting.
Methodology: In this study, 63 patients subjected to coronary artery bypass grafting surgeries were randomized using closed envelope technique into three equal groups:
Group (IG) (N=21): Patients will receive 500cc of glucose 10% that contains 50g of glucose and provides patients with 200Kcal with 556mosmoles/L.
Group (IIS) (N=21): Patients will receive 100cc of SMOFlipid FRESENIUS KABI (soybean 30%, medium chain triglycerides 30%, olive oil 25%, fish oil 15% and 20mg Vitamin E) that contains 20g lipid and provides patients with 200Kcal with osmolarity of 380mosmoles/L.
Group (IIIC) (N=21): Patients will be fasting overnight from 11pm till 9am except for clear fluids that will be allowed till 5am.
The outcome that was investigated is the need of inotropic support intraoperatively.
Results: For obese patients who undergone coronary artery bypass grafting surgeries pre-operative infusion of lipid emulsion enriched with medium chain triglycerides and fish oil resulted in reduction in levels inotropic support, when compared with traditional fasting and pre-operative carbohy-drate infusion.
Conclusion: Pre-operative infusion of lipid emulsion enriched with medium chain eed of inotropic support.