Oral carbohydrate solution cause an inflammatory response when aspirated into the lungs in mice
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ORIGINAL ARTICLE
Oral carbohydrate solution cause an inflammatory response when aspirated into the lungs in mice Joungmin Kim1 · Hyung‑Seok Kim2 · Minji Kim1 · Hong‑Beom Bae1 · Jeong‑Il Choi1 Received: 1 April 2020 / Accepted: 2 November 2020 © Japanese Society of Anesthesiologists 2020
Abstract Purpose Many studies have been published on the beneficial effects of oral carbohydrate solutions (OCS) administered prior to surgery. However, the risk of pulmonary aspiration cannot be excluded in all patients undergoing anesthesia. But, there are few studies on the safety of OCS at lung aspiration. Methods Experiments were conducted with mice (Nine- to ten-week-old male BALB/c mice weighted 23–26 g). Lung aspiration was performed by intratracheal administration of OCS and its major constituents, fructose and maltodextrin. Bronchoalveolar lavage fluid (BALF) was collected 3 and 24 h after lung aspiration. The level of Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and macrophage inflammatory protein-2 (MIP-2) were measured in BALF. The total white blood cell, neutrophil counts, wet to dry ratio and histological examination were performed in BALF and lung tissue, respectively, at 24 h after aspiration. Results The OCS increased the level of TNF-α, IL-6 and MIP-2 at 3 h and the neutrophil count at 24 h in BALFs, compared to a phosphate-buffered saline (PBS) group. The increase in IL-6 level induced by OCS was maintained for 24 h. The OCS also increased the number of white blood cells and the percentage of neutrophils in BALFs. Compared to fructose, maltodextrin significantly increased the production of MIP-2 in BALFs. OCS and maltodextrin also increased neutrophil recruitment in lung tissue. Conclusion Aspiration of OCS may cause inflammation of the lungs. The preoperative use of OCS may require caution under specific clinical conditions, such as patients at risk of lung aspiration. Keywords Oral carbohydrate solution · Preoperative fasting · Aspiration pneumonia · Maltodextrin · Fructose
Introduction Pre-operative fasting is performed to reduce the incidence of aspiration pneumonia due to reflux of gastric contents during anesthesia [1, 2]. However, this leads to thirst, hunger, and metabolic disturbances such as glucose intolerance, in the fasting patient [3]. Recently, Enhanced Recovery After * Hong‑Beom Bae [email protected] * Jeong‑Il Choi [email protected] 1
Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo‑ro, Dong‑gu, Gwangju 501‑746, Korea
Department of Forensic Medicine, Chonnam National University Medical School, Hwasun, Korea
2
Surgery (ERAS) programs attempted to reduce insulin resistance through preoperative oral carbohydrate loading [4]. Oral carbohydrate solution (OCS) ingestion prior to surgery can reduce the inconvenience to the patient, enhance postoperative recovery and shorten the hospital stay [5–7]. OCS consists of water and nutritional substances, such as carbohydrates and amino ac
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