Perioperative Medicine  |   October 2016
Impact of a Potassium-enriched, Chloride-depleted 5% Glucose Solution on Gastrointestinal Function after Major Abdominopelvic Surgery: Results of a Randomized Controlled Trial
Author Notes
  • From the Departments of Anaesthesiology and Pain Medicine (L.M.L., P.Y.W.), Urology (F.C.B.), and Intensive Care Medicine (J.T.), Inselspital, Bern University Hospital, Bern, Switzerland; and Department of Anaesthesia, Kantonsspital, Lucerne, Switzerland (L.M.L.).
  • Submitted for publication December 17, 2015. Accepted for publication June 15, 2016.
    Submitted for publication December 17, 2015. Accepted for publication June 15, 2016.×
  • Address correspondence to Dr. Wuethrich: Department of Anaesthesiology and Pain Medicine, Bern University Hospital, CH-3010 Bern, Switzerland. patrick.wuethrich@insel.ch. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Gastrointestinal and Hepatic Systems / Renal and Urinary Systems / Electrolyte Balance
Perioperative Medicine   |   October 2016
Impact of a Potassium-enriched, Chloride-depleted 5% Glucose Solution on Gastrointestinal Function after Major Abdominopelvic Surgery: Results of a Randomized Controlled Trial
Anesthesiology 10 2016, Vol.125, 678-689. doi:10.1097/ALN.0000000000001238
Anesthesiology 10 2016, Vol.125, 678-689. doi:10.1097/ALN.0000000000001238
Abstract

Background: Gastrointestinal (GI) complications often delay recovery after radical cystectomy with urinary diversion. The authors investigated if perioperative administration of a potassium-enriched, chloride-depleted 5% glucose solution (G5K) accelerates recovery of GI function.

Methods: This randomized, parallel-group, single-center double-blind trial included 44 consecutive patients undergoing radical cystectomy and pelvic lymph node dissection with urinary diversion. Patients were randomized to receive either a G5K (G5K group) solution or a Ringer’s maleate solution (control group). Fluid management aimed for a zero fluid balance. Primary endpoint was time to first defecation. Secondary endpoints were time to normal GI function, need for electrolyte substitution, and renal dysfunction.

Results: Time to first defecation was not significantly different between groups (G5K group, 93 h [19 to 168 h] and control group, 120 h [43 to 241 h]); estimator of the group difference, −16 (95% CI, −38 to 6); P = 0.173. Return of normal GI function occurred faster in the G5K group than in the control group (median, 138 h [range, 54 to 262 h] vs. 169 h [108 to 318 h]); estimator of the group difference, −38 (95% CI, −74 to −12); P = 0.004. Potassium and magnesium were less frequently substituted in the G5K group (13.6 vs. 54.5% [P = 0.010] and 18.2 vs. 77.3% [P < 0.001]), respectively. The incidence of renal dysfunction (Risk, Injury, Failure, Loss and End-stage kidney disease stage “risk”) at discharge was 9.1% in the G5K group and 4.5% in the control group; P = 1.000.

Conclusions: Perioperative administration of a G5K did not enhance first defecation, but may accelerate recovery of normal GI function, and reduces potassium and magnesium substitution after radical cystectomy and urinary diversion.