P007: IMPACT OF ORAL CARBOHYDRATE BEVERAGES ON WELL-BEING PRIOR TO CESAREAN SECTION
Adam Wendling, MD, Sharon Byun, MD, Terrie Vasilopoulos, PhD, Megan Koenig; University of Florida
Introduction: Oral carbohydrates (CHO) prior to a variety of surgical procedures has been found to attenuate the postoperative catabolic state with an improvement in well-being insulin sensitivity, cardiac output and shortened hospital stays without adverse effect. Previous work has compared oral CHO to water or flavored water and all previous work excluded pregnant women. To date, no work has compared higher dose CHO beverages specifically made for preoperative consumption to common commercial oral rehydration solutions with lower carbohydrate concentrations. Our primary aim was to determine if preoperative oral consumption of higher dose CHO would improve patient well-being (WB-VAS) prior to cesarean section compared to a widely available rehydration beverage with a lower CHO dose and fasted controls.
Methods: Low risk women undergoing scheduled cesarean deliveries under spinal anesthesia were recruited. Participants were randomized to either: Clearfast® (group CHO), Gatorade Thirst Quencher® (group R) or fasting control (group F). Participants in groups CHO and R received 710mL of either beverage the night before and 355mL two hours prior to surgery. Participants in Group F fasted after midnight the night before surgery. Two hours before surgery, baseline WB-VAS was recorded, followed by beverage consumption for groups CHO and R. One hour later, WB-VAS was repeated. Additional recorded measures included umbilical blood glucose, intraoperative variables, breastfeeding success, and quality of recovery one day after surgery.
Results: Analyses were performed in JMP Pro 13 (SAS Institute Inc., Cary NC). Group differences in change in WB-VAS were analyzed using linear regression. These analyses included group status and time 1 WB-VAS as independent variables and time 2 WB-VAS as dependent variable. Including time 1 as an independent variable creates a “residual change score” in outcome. Both group CHO and R showed significant improvements in WB-VAS while fasted patients showed no change. There were no differences in other outcomes including quality of recovery, breastfeeding success, umbilical blood glucose, neonatal resuscitation measures or maternal intraoperative vasopressor use.
Conclusion: Either the common oral rehydration or higher dose CHO beverage resulted in superior well-being compared to fasting with no difference in other outcomes. Consuming any CHO beverage prior to scheduled cesarean section in low risk patients seems to be a means to improve patient comfort as compared to fasting.