Polyethylene glycol 3350/Potassium chloride/Sodium bicarbonate/Sodium chloride/Sodium sulfate

At a gastrointestinal endoscopy unit in a large, urban hospital system, the standard preparation (prep) for colonoscopy procedures was a combination of polyethylene glycol 3350 with electrolytes (Golytely) in addition to magnesium citrate until magnesium citrate underwent a national recall in July 2022. At the time of the recall, the facility had over 800 patients scheduled who had already received the recalled medication. The methods used in this project include collaboration with the interdisciplinary team to handle all aspects of the recall with a systematic approach and utilization of this unforeseen event to initiate tracking bowel prep compliance and prep quality with varied types of bowel preps utilizing a bowel prep rating scale. Of the over 800 patients scheduled at the time of the recall, 99.6% were prevented from ingesting the recalled medication. The colonoscopy prep compliance rate was 82.3%, and bowel prep quality was considered adequate in 97.7% of completed outpatient colonoscopies. This article highlights the importance of working with an interdisciplinary team during unplanned large-scale events to provide safe and effective care to patients, as well as finding positives in a challenging situation. This project includes the following commercial content: magnesium citrate, Golytely, MoviPrep, and Boston Bowel Preparation Score.

Insulin resistance (IR) is one of the independent determinants influencing the length of hospital stay (LOH) and postoperative complications in colorectal procedures. Preoperative oral carbohydrate loading (POCL) has emerged as a prospective countermeasure for IR. This study aimed to investigate the effects of preoperative carbohydrate loading on postoperative IR, inflammatory parameters, and clinical outcomes in patients undergoing elective colorectal surgery.

This was an open-label, parallel arm, superiority randomized controlled trial conducted over 2 years. Participants were assigned to conventional fasting (CF) and oral carbohydrate loading (OCL) groups. Insulin resistance, insulin sensitivity, Glasgow Prognostic Score (GPS), and IL-6 levels were analyzed on the day of surgery, and the first and third postoperative days. Clinical parameters like thirst, hunger, dry mouth, anxiety, weakness, pain, nausea, and vomiting were compared in the perioperative period. Surgical clinical outcomes such as intestinal recovery, time to independent ambulation, postoperative morbidity, and LOH were also studied.

A total of 72 participants were included, with 36 in each group. In the OCL group, there was a statistically significant decrease in postoperative insulin resistance during preop, POD-1 and POD-3 (p=0.0336). Similarly, inflammatory parameters and the Glassgow prognostic scale were found to be significantly lower in the OCL group (p<0.001). Clinical parameters such as thirst, hunger, and dry mouth were significantly lower in the intervention group (p=0.00) with a shortened LOH.

This study demonstrated that preoperative carbohydrate loading is associated with reduced insulin resistance and inflammatory markers, shortened hospital stays, and improved overall clinical outcomes in elective colorectal surgery.