Drug – bio-affecting and body treating compositions – Designated organic active ingredient containing – Carbohydrate doai
Patent
1993-06-21
1995-08-01
Henley, III, Raymond
Drug, bio-affecting and body treating compositions
Designated organic active ingredient containing
Carbohydrate doai
514 53, 514 54, A61K 3170, A61K 31715
Patent
active
054380430
DESCRIPTION:
BRIEF SUMMARY
This application is a 371 of PCT/SE91/00897, filed Dec. 20, 1991.
The present invention relates to a beverage intended for use before elective surgery, and the use of a solution of carbohydrates as such a beverage, and the use of carbohydrates or a carbohydrate mixture for the preparation of such a beverage.
Approximately 2-300 000 elective (i.e. not emergency) surgical operations under general anaesthesia are performed annually in Sweden alone. A routine operation always brings about a relatively long period (weeks) of convalescence for physical recovery. Routinely, elective surgery is performed after a fasting period beginning at midnight to the day of the operation. The effective fasting period, however, lasts at least 16-18 hours, since the last meal on the day before surgery is served around 16.00 h. The obligatory fast before surgery has been introduced for reasons of safety in connection with anaesthesia, primarily in order to prevent the regurgitation of acid stomach content into the lungs, and has not been considered to bring about any negative effects for the patient.
However, a considerable change in the metabolism occurs already during brief fasting, such as the pre-operative fasting period. The most important alteration is the consumption of the carbohydrate reserves of the body (primarily in form of glucose stored as glycogen in the liver). The requirements of the brain for glucose, however, remains unchanged during the first few days of fasting. In order to satisfy this requirement during fasting, body metabolism is changed so that new glucose can be produced. This is accomplished by the degradation of carbohydrate reserves outside the liver (mainly muscle), breakdown of proteins in muscle to amino acids, mainly alanine and glutamine, as well as fat degradation. The released substances are transported to the liver for new glucose formation. In order to enable the degradation of energy depots, the hormonal release is changed and thereby body metabolism is changed from anabolism (augmenting energy loading and new tissue building) into a state of catabolism (energy and tissue breakdown). This shift in metabolism constitutes a normal part of body metabolism, and is present after for example an over night sleep with fasting. When the first meal is consumed in the morning, the body responds with release of other hormones, primarily insulin, which augments the storage of carbohydrates, proteins and fat.
Thus, even a brief fast, such as preoperative fasting, leads to two essential changes in body metabolism. Both can be closely related to the metabolism of carbohydrates: physical stress and trauma, as well as for the recovery after stress and surgery.
It has been shown that exhaustion of the carbohydrate reserves (glycogen) in the liver, which occurs already after brief fasting (5-24 h in the rat and in man), has been shown to significantly increase mortality after experimental hemorrhage and endotoxemia. During hemorrhage, it has been proven that the glycogen reserve is rapidly released as glucose to the circulation, where increased glucose levels was registered. This increase in blood glucose causes fluid mobilization from the greater reserves of fluid in the body located inside the cells, into the circulation. The development of increasing blood glucose levels thereby constitutes an important part of the body's own defence during bleeding, and this potential is markedly reduced after already a brief period of fasting. This mechanism exists in the majority of mammals including man. In accordance, the preoperative fasting period reduces the availability of glucose in the body, and thus causes a considerable reduction in this part of blood volume defence in case of hemorrhage during of after surgery.
In all types of physical trauma (of which elective surgery is perhaps the greatest in terms of volume) body metabolism is rapidly changed. The normal balance between anabolism and catabolism is markedly displaced towards catabolism. Of cardinal importance for this change to develop, is the reduced effec
REFERENCES:
patent: 4303684 (1981-12-01), Pitchon et al.
patent: 4734402 (1988-03-01), Hashimoto et al.
patent: 5032411 (1991-07-01), Stray-Gundersen
Henley III Raymond
Olle Ljungqvist Medical AB
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