- Complications such as post-operative
atrial fibrillation (POAF) and infection may occur after coronary artery
bypass graft (CABG) surgery and can retard recovery.
- Carbohydrate and omega-3 fatty acid
administration to the patient in the perioperative period can reduce these
complications and aid recovery
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
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.
‘Incidence of atrial fibrillation following coronary artery bypass graft surgery can be reduced by giving carbohydrate and omega-3 polyunsaturated fatty acid (ω-3 PUFA) supplements in the perioperative period.’
The current study aimed to assess incidence of post-operative atrial fibrillation and
patient morbidity following surgery
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
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.
assigned to 1 of the following 4 groups
- Only preoperative carbohydrate
loading (CHO group) - 14 patients
- Preoperative water only (controls) -
- 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
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.
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.
- Omega-3 polyunsaturated fatty acids in cardiac
surgery patients: An updated systematic review and meta-analysis -