• Bora Lee, Sarah Soh, Jae-Kwang Shim, Ha Y Kim, Hyelin Lee, and Young-Lan Kwak.
• From the Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute (BL,SS, J-KS, HYK, HL, Y-LK); and Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J-KS, Y-LK).
• Eur J Anaesthesiol. 2017 Nov 1; 34 (11): 740-747.

BackgroundIn fasting cardiac surgery patients, preoperative carbohydrate (CHO) drink intake attenuated insulin resistance and improved cardiac metabolism, although its beneficial effects were not evident after cardiac surgery possibly due to cardiopulmonary bypass-related extreme systemic inflammation.ObjectiveWe aimed to evaluate whether preoperative CHO intake affected insulin resistance and free-fatty acid (FFA) concentrations in off-pump coronary revascularisation.DesignA randomised controlled trial.SettingPrimary care in a university hospital in Korea from January 2015 to July 2016.PatientsSixty patients who underwent elective multi-vessel off-pump coronary revascularisation were randomised into two groups. Three patients were excluded from analysis and 57 patients completed study.InterventionThe CHO group received oral CHO (400 ml) the prior evening and 2 to 3 h before surgery, and the control group was fasted from food and water according to standard protocol.Main Outcome MeasuresInsulin resistance was assessed twice, after anaesthetic induction and after surgery via short insulin tolerance test. FFA, C-reactive protein and creatine kinase-myocardial band concentrations were determined serially for 48 h after surgery.ResultsInsulin sensitivity was greater (P = 0.002) and plasma FFA concentrations were lower (P = 0.001) after anaesthetic induction in the CHO group compared with the Control group, although there were no intergroup differences after surgery. The postoperative peak creatine kinase-myocardial band concentration was significantly lower in the CHO group compared with the Control group [8.8 (5.4 to 18.2) vs. 6.4 (3.5 to 9.7) ng ml, P = 0.031].ConclusionA preoperative CHO supplement significantly reduced insulin resistance and FFA concentrations compared with fasting at the beginning of the surgery, but these benefits were lost after off-pump coronary revascularisation. Despite their transient nature, these beneficial effects resulted in less myocardial injury, mandating further studies focused on the impact of preoperative CHO on myocardial ischaemia and cardiac function after coronary revascularisation.Trial RegistrationClinicaltrials.gov identifier: NCT 02330263.

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