Administering Carbohydrates and Omega-3 Fatty Acids Before & During Heart Surgery Reduces Later Complications

Carbohydrate and omega(ω)-3 PUFA nutrients given in the perioperative period is beneficial for recovery of patients undergoing CABG, according to a research team at General University Hospital, Cuiabá, Brazil.

Reason For Study

Previous studies have shown that preoperative carbohydrate loading is beneficial in reducing occurrence of post-operative insulin resistance. Also incidence of post-operative nausea and vomiting (PONV) was decreased. In addition various studies have shown that perioperative supplementation of ω-3 PUFA improved post-operative outcome in patients undergoing abdominal surgery. A recent study has also indicated that perioperative ω-3 PUFA administration was associated with a better outcome in patients who underwent open heart surgery.

The current study aimed to assess incidence of post-operative atrial fibrillation and patient morbidity following surgery by combining a regimen of pre-operative carbohydrate loading followed by intraoperative ω-3 PUFA infusion.

Methods of the Study

The study was a randomized, double blind trial (neither patients participating nor the

doctors performing the surgery or involved in collecting the patient data were aware of details of patient selection for nutrient supplementation) conducted in a Brazilian Hospital.

Fifty seven patients undergoing CABG surgery were randomly assigned to 1 of the following 4 groups.

• Only preoperative carbohydrate loading (CHO group) – 14 patients
• Preoperative water only (controls) – 14 patients
• Preoperative carbohydrate loading plus intraoperative ω-3 PUFA infusion (CHO + W3 group) – 15 patients
• Only intraoperative ω-3 PUFA infusion (W3 group) – 14 patients

Perioperative clinical and lab parameters and mortality rates were collected and analyzed, examining the incidence of POAF, as well as the need for drugs to maintain blood pressure and heart rate (vasoactive agents) during the operation and in the intensive care unit (ICU) postoperatively.

Results of the Study

• Patients who received carbohydrate (CHO) supplementation had lesser incidence of hospital infection.
• Patients who received CHO supplementation had a lesser requirement of vasoactive agents during the operation and during the ICU stay after the operation.
• Incidence of POAF was markedly less in patients who received ω-3 PUFA infusion during the surgery.

In short, perioperative administration of carbohydrate load and ω-3 PUFA infusion improves the outcome for patients undergoing CABG with regards to incidence of POAF, hospital infection, and reliance on vasoactive agents. These led to a shorter hospital stay and quicker recovery.

Role of Carbohydrates and ω-3 PUFA in Surgery Patients

One of the emerging trends in surgery patients is doing away with a prolonged fasting period prior to surgery. Many anesthesiologist groups and societies have begun to endorse this practice.

• A carbohydrate load given 2 hours prior to surgery has been shown to decrease insulin resistance following surgery, decrease nausea and vomiting postoperatively as well as pangs of hunger and thirst after surgery.
• Omega-3 PUFA containing nutrients have been found to reduce incidence of infection and inflammation following surgery. In addition, they are believed to possess anti-arrhythmic properties as well and can decrease incidence of atrial fibrillation in patients undergoing surgery.
• In the field of Cardiology, ω-3 PUFA has been proven to be of benefit in controlling dyslipidemias and inherent complications.

Though this is a small study as the authors caution, the benefit of ω-3 PUFA in reducing the incidence of POAF was significant. Further studies involving larger number of patients may be required to validate these findings.

References:

1. Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An updated systematic review and meta-analysis - (https://www.ncbi.nlm.nih.gov/pubmed/27293143)

Source-Medindia