Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia
背景與目的
術前禁食是兒科患者圍術期不適的主要原因，且可導致術後胰島素抵抗，從而增強手術炎症反應。患兒術前攝入碳水化合物是否可降低這些情況的發生，目前尚不清楚。
方 法
本試驗共納入2歲至18歲的患兒120例，隨機分為對照組和試驗組，對照組術前按照6h固體食物、4h母乳、2小時清飲的常規標準禁食，試驗組在胃鏡檢查前夜和檢查前2h各口服PreOp牌檸檬口味的碳水化合物溶液5ml/kg。在胃鏡檢查時通過胃鏡吸除胃內容物，記錄其容積和pH值。記錄術前不適感評分、口渴和飢餓情況以及術後噁心嘔吐發生情況 。四歲（含）以下使用觀察性疼痛量表（OPS），四歲以上使用VAS評分。
結 果
與對照組相比，試驗組患兒胃內容物顯著減少（p=0.01），術後噁心發生率更低（p=0.028），術後嘔吐發生率無顯著差異。試驗組僅1例術前VAS評分大於5分，而對照組則有5例。合併腸鏡檢查組胃內容物體積並不高於單純胃鏡檢查組，其他研究結果也與單純胃鏡檢查組相同。
結 論
術前給予碳水化合物可減少胃內容物，降低患兒術後噁心發生風險，這為兒童麻醉術前禁食標準的制定提供了依據。
原始文獻摘要
TudorDrobjewski BA, Marhofer P, Kimberger O, et al. Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia. Br J Anaesth. 2018 Sep;121(3):656-661. doi: 10.1016/j.bja.2018.04.040
Backgrand:
Preoperative fasting is a major cause of perioperative discomfort in paediatric anaesthesia and leads to postoperative insulin resistance, thus potentially enhancing the inflammatory response to surgery. Addressing these problems by preoperative carbohydrate intake has not been a well-defined approach in children.
Methed:
We randomised 120 children scheduled for gastroscopy under general anaesthesia to either a control group of standard preoperative fasting or a study group receiving a carbohydrate beverage (PreOp™; Nutricia, Erlangen, Germany).Their stomach contents were aspirated endoscopically, and the volume and pH measured. Perioperative discomfort was evaluated using, among other parameters, an observational pain scale in 4-yr-olds and a VAS in >4yr-olds. The investigatorsdoing he endoscopies and outcome evaluations were blinded to the study group allocation.
Results：Compared with fasting, carbohydrate loading was associated with significantly less gastric content (P¼0.01),fewer patients experiencing postoperative nausea (P¼0.028), with no significant difference in postoperative vomiting.High preoperative VAS scores (>5) were recorded for only one child in the carbohydrate group vs five children in the fasting group. Bowel cleansing for simultaneous colonoscopies (n¼61) made no difference to any of the intergroup findings.
Conclusion: Preoperative carbohydrates can reduce nausea and gastric content, the latter being a surrogate parameter for the risk and severity of gastric aspiration into the lungs during anaesthesia. Our study adds knowledge for preoperative fasting guidelines in paediatric anaesthesia
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