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Biography

Gibran Roder Feguri has completed his PhD from Federal University of Mato Grosso and is pursuing his Post-doctoral studies. He is a specialist in Cardiovascular Surgery and Artificial Cardiac Stimulation by the Brazilian Society of Cardiovascular Surgery (BSCVS). He is currently the Head of the Medical Residency Program in Cardiovascular Surgery at the General University Hospital (HGU/UNIC) and is a Professor at the same institution. He has published more than 10 papers in reputed journals and has been serving as a Reviewer in the Brazilian Journal of Cardiovascular Surgery, among others.

Abstract

Background: A strategy of limited preoperative fasting, with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA), has seldom been tried in surgery.

 

Aim: The aim of this study was to evaluate clinical variables, mortality and effects on the metabolism and inflammation after coronary artery bypass grafting (CABG)/cardiopulmonary bypass (CPB) in combination, if preoperative fasts are curtailed in favor of CHO loading, and ω-3 PUFA are infused intraoperatively.

 

Methods: Fifty-seven patients were randomly assigned to receive 12.5% maltodextrin (200ml, 2h before anesthesia), (CHO, n=14); water (200ml, 2h before anesthesia), (controls, n=14); 12.5% maltodextrin (200ml, 2h before anesthesia) plus intraoperative ω-3 PUFA (0.2g/kg) (CHO+W3, n=15); or water (200ml, 2h before anesthesia) plus intraoperative ω-3 PUFA (0.2g/kg) (W3, n=14). Insulin resistance and glucose control were analyzed.

 

Results: Two deaths occurred (3.5%), but there were no instances of bronchoaspiration and mediastinitis. Patients given preoperative CHO loads experienced fewer instances of hospital infection (P<0.05) and were less reliant on vasoactive amines during surgery (RR=0.60, 95% CI: 0.38-0.94; P=0.020), and while recovering in ICU (P=0.008). Groups given ω-3 PUFA experienced significantly fewer instances of POAF (RR=4.83, 95% CI: 1.56-15.02; P=0.001). Patients given preoperative CHO loads also got better glycemic control in ICU (P=0.015) and less need for exogenous insulin (P=0.018). Patients in the W3 Group presented lower values of the ultrasensitive CRP with 36 h of PO (P=0.008).

 

Conclusion: When implemented in conjunction with CHO loading and infusion of ω-3 PUFA during surgery, expedited recovery from CABG was observed.