Metabolic Stress Response Attenuate by Oral Glucose Preoperatively in Patient Underwent Major Surgery with General Anesthesia

Abstract Background: Fasting, anesthesia and surgery lead to metabolic stress response. Increase of cortisol level lead to insulin resistance and hyperglicemic state has significant effect to the wound healing and increase morbidity and mortality to the patient undergoing surgery. The aim of this research is to prove that preoperative oral glucose loading can decrease metabolic stress response and also the difference effect on preoperative oral glucose that given twice and once time to decrease metabolic stress response in patient undergoing major oncology surgery. Methods and Materials: Fifty four patients undergoing major oncology surgery were randomly selected with consecutive sampling method. Patient was divided into 3 groups and each groups consisted of 18 peoples, first treatment group was given oral glucose solution preoperatively at night and early morning, second treatment group was given oral glucose solution in the morning preoperatively and the control groups were given only mineral water at night and early morning preoperatively. The blood glucose and cortisol level was measured at the morning before surgery and after surgery. Comparative analysis based on the normality test, One Way Anova test for the normal distribution data and Kruskal-Wallis test if the data distribution is not normal. Post hoc tests was using LSD test. Result: The increase of blood glucose level significantly lower on first treatment group compared to control group (p=0.041). The increase of cortisol level significantly lower on first treatment group compared to both of second treatment and control groups (p<0.001). Conclusion: Preoperative oral glucose loading reduce the increase of blood cortisol and glucose level postoperatively compared with patients who fasted preoperatively. Then, giving an oral glucose twice (evening and morning) preoperatively more effective to reduce the increase of cortisol and blood glucose level postoperatively compared with patients who given oral glucose only in the morning preoperatively.