Efeito da abreviação do jejum pré-operatório com carboidratos e proteínas do soro do leite na resposta inflamatória e resistência insulínica em pacientes submetidos à colecistectomia ou herniorrafia inguinal

Abstract

Introduction: Prolonged preoperative fasting increases insulin resistance. A sustained body of evidence recommends the abbreviation of preoperative fasting to 2h with beverages containing carbohydrates (CHO). We hypothesized that the addition of proteins to preoperative drink is not only safe but may reduce the inflammatory response after elective cholecystectomies and herniorraphies. Methods: A total of 17 patients were randomized to receive 474mL and 237 mL of either water or a beverage containing CHO and proteins (CHO-P) (Resource Breeze, Nestlé, Brasil; composition: sacarose, maltodextrina, whey protein isolate, 250 kcal; 84% CHO; 14% protein; 0% fat; 750 mOsm/L) 6 and 3h before operation. Blood samples were collected in the morning before operation and 24h after the end of the surgery for various biochemical assays. The prognosis inflammatory and nutritional index (PINI), insulin resistance and C-reactive protein/albumin ratio was calculated and compared between groups. A 5% level was established for significance level. Results: There was no mortality neither postoperative complications. Postoperative insulin resistance was lower in CHO-P compared to the CO group (2.75 ± 0.72 vs. 5.74 ± 1.16 p = 0.03). This was evidenced by a lower rate of blood glucose and serum insulin in the postoperative period. There was no difference between groups to IPIN, but the use of this beverage decreased the magnitude of the elevation of CRP and the ratio CRP / albumin. The proportion of patients who presented CRP / albumin considered normal was significantly higher (p = 0.05) in CHO-P (87.5%) than in the CO group (33.3%). Conclusion: The abbreviation of preoperative fasting with CHO plus WP is safe, and provided less insulin resistance and inflammation post trauma.