Resultados clínicos e metabólicos da abreviação do jejum com carboidratos na revascularização cirúrgica do miocárdio

Abstract

Introduction: Limited information is available about preoperative fasting abbreviation with administration of liquid enriched with carboidrates (CHO) in cardiovascular surgeries. Objectives: To assess clinical variables, security of the method and effects on the metabolism of patients undergoing fasting abbreviation in coronary artery bypass graft (CABG) surgery. Methods: Forty patients undergoing CABG were randomized to receive 400ml (6h before) and 200ml (2h before) of maltodextrin at 12.5% (Group I, n=20) or only water (Group II, n=20) before anesthetic induction. Perioperative clinical variables were assessed. Insulin resistance (IR) was assessed by Homa-IR index and also by the need of exogenous insulin; pancreatic beta-cell excretory function by Homa-Beta index and glycemic control by tests of capillary glucose. Results: Deaths, bronchoaspiration, mediastinitis, stroke and AMI did not occur. Atrial fibrillation occurred in two patients of each group and infectious complications did not differ among groups (P=0.611). Patients of Group I presented two days less of hospital stay (P=0.025) and one day less in the ICU (P<0.001). The length of time using dobutamine was shorter in Group I (P=0.034). Glycemic control in the first 6h after surgery was worse for Group II (P=0.012). IR was verified and did not differ among groups (P>0.05). A decline in the endogenous production of insulin was observed in both groups (P<0.001). Conclusion: Preoperative fasting abbreviation with the administration of CHO in the CABG was safe. The glycemic control improved in the ICU; there was less time in the use of dobutamine and length of hospital and ICU stay was reduced. However, neither IR nor morbimortality during hospital phase were influenced.