Effects of new formulated preoperative oral carbohydrate solution on; gastric emptying, postoperative nausea, vomiting and stress response

İntroduction and Objectives: The current preoperative fasting guidelines recommends, applying preoperative carbohydrate solution 2 hours before the operation for minimizing prolonged fasting times potential negative effects and improving patient comfort. Fasting after midnight before the operation day is a widespread practice. The major obstacle of preoperative carbohydrate solutions becoming prevalent and extremely long fasting times are the limited product; which is proven safety and efficiency, and unavailable in several countries. In this study, our objective is to analyze gastric volume, preoperative anxiety, stress response, postoperative insulin resistance, and postoperative nausea and vomiting by utilizing a low osmolality oral carbohydrate solution prepared with ginger and melissa. Material and Method: 109 patients who underwent elective laparoscopic cholecystectomy, aged 18-65 years and ASA physical state 1-2 were included in the study. The patients were divided into 3 groups: Group A, who would not eat anything 6-8 hours before the operation, Group S, who drank 400 ml of water 2 hours before the operation, and Group K, which drank 400 ml preoperative oral carbohydrate solution (PreOKH) 2 hours before the operation. Before induction of anesthesia (T1), patients antral gastric cross-sectional area (GKA) and gastric volume (GV) were evaluated by gastric ultrasound. The preoperative anxiety level of the patients was determined by the State-Trait Anxiety Inventory (STAl) before the operation (T1), and the symptoms affecting the preoperative patient comfort parameters (thirst, hunger, dry mouth, fatigue) were measured 2 hours before the operation (T0) and before the induction (T1) evaluated with the visual analog scale (VAS). Postoperative nausea and vomiting (PONV) and postoperative pain levels were recorded. Blood glucose, insulin and cortisol levels of the patients were measured 2 hours before the operation (T0), before induction (T1) and postoperative 2nd hour (T3). Results: GKA, GV and GV/kg values in Group K were statistically significantly lower than in Group A (p=0.021, p=0.037, p=0.020). Preoperative anxiety scores of Group K were decreased compared to Group A and Group S (p=0.004). Thirst, hunger, dry mouth VAS scores of Group A increased compared to Group K and Group S (p<0.001, p=0.008, p<0.001). Fatigue VAS score of Group K decreased compared to Group A (p= 0.011). In Group K, the PONV rate at T3 was significantly lower compared to the other groups, and the postoperative vomiting rate was lower compared to Group A (p<0.001, p<0.001). The need for additional antiemetics were higher in Group A (p=<0.001, p=0.010) Postoperative pain values of the patients were significantly lower in Group K than the other groups (p=0.007). In Group K, glucose and insulin levels increased statistically significantly at T3 (p<0.001). Conclusion: PreOKH enriched with ginger and melissa can be used safely up to 400 ml 2 hours before the operation without causing pulmonary aspiration and delaying gastric emptying. PreOKH is especially effective in preventing preoperative anxiety and PONV. These findings suggest that PreOKH can be safely employed as an alternative to traditional fasting practices, offering potential benefits in enhancing the overall perioperative experience for patients undergoing this surgical procedure. Keywords: preoperative fasting; preoperative oral carbohydrate solution; gastric ultrasonography.