Effect of preoperative oral carbohydrate on the postoperative recovery quality of patients undergoing daytime oral surgery: a randomized controlled trial

Effect of preoperative oral carbohydrate on the postoperative recovery quality of patients undergoing daytime oral surgery: a randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of preoperative oral carbohydrate on the postoperative recovery quality of patients undergoing daytime oral surgery: a randomized controlled trial Weixiang Tang, Gaige Meng, Chen Yang, Yue Sun, Weiwei Zhong, Yao Lu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4954722/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Oct, 2024 Read the published version in Perioperative Medicine → Version 1 posted 7 You are reading this latest preprint version Abstract Background Preoperative oral carbohydrate intake can improve the postoperative recovery of fasting patients in many kinds of surgeries; however, the effect of carbohydrates on patients undergoing daytime oral surgery is still unclear. This study was designed to evaluate the effect of preoperative oral carbohydrate intake on the quality of recovery of patients undergoing daytime oral surgery using the quality of recovery-15 (QoR-15) questionnaire. Methods Ninety-two patients scheduled for daytime oral surgery were randomly allocated to the midnight fasting group (F group, n = 45) or the carbohydrate-Outfast loading group (O group, n = 47). Participants in the F group fasted from midnight the day before surgery. Patients in the O group also fasted but received the Outfast drink (4 ml/kg) 2–3 hours before the induction of anesthesia. QoR-15 questionnaire, patient well-being and satisfaction were assessed before anesthesia induction and 24 hours after surgery. Perioperative blood glucose, postoperative exhaust time and adverse events were also recorded. Results The QoR-15 scores were significantly higher in the O group than in the F group preoperatively and postoperatively. Seven parameters representing patient well-being evaluated on numeric rating scale (NRS, 0–10) were lower in the O group than in the F group postoperatively, except for the hunger and sleep quality scores. Patient satisfaction scores on a 5-point scale were higher in the O group than in the F group preoperatively and postoperatively. Meanwhile, the postoperative exhaust time was significant shorter in the O group compared to the F group, while there were no significant differences in blood glucose concentrations between these two groups. Conclusions Preoperative oral carbohydrate intake could improve postoperative recovery quality, well-being and satisfaction of patients undergoing daytime oral surgery 24 hours after surgery, and may serve as a treatment option for patients undergoing daytime oral surgery. Trial registration: This trial was registered in the Chinese Clinical Trial Registry (ChiCTR2100053753) on 28/11/2021. preoperative oral carbohydrate quality of recovery-15 daytime oral surgery Figures Figure 1 Figure 2 Figure 3 Background Fasting from midnight before surgery is a standard practice among patients undergoing elective surgery to reduce the risk of pulmonary aspiration under anesthesia [1]. However, accumulated evidence revealed that midnight fasting does not decrease the volume and acidity of stomach content related to perioperative complications [2]. Conversely, long-term fasting could lead to insulin resistance and postoperative discomforts such as thirst, hunger, and anxiety [2–4], which has an association with prolonged length of hospital stay. Additionally, as patients receiving daytime oral surgery often have difficulty opening the mouth and chewing after the operation, the fasting time is even longer. As a result, excessive fasting may reduce the quality of postoperative recovery of patients undergoing daytime oral surgery. Preoperative carbohydrate intake is implemented as part of enhanced recovery after surgery (ERAS) and has been shown to alleviate some of the discomforts associated with fasting during the perioperative period [5]. However, certain studies suggest that preoperative carbohydrate intake may not significantly improve postoperative recovery or have a minimal effect. The variability in results could be attributed to inadequate blinding and differences in patient populations. [6–8]. Outfast is a kind of carbohydrate (osmotic pressure 280–300 mmol/L, pH 3.8–4.3, contents per 100 ml: 14.2 g carbohydrate, 45 mg sodium, 0.24 mg vitamin B1, 0.13 mg vitamin B6, 0.14 mg vitamin B12, and 1.48 mg zinc) used for the perioperative fasting of patients under general anesthesia to provide energy and a nutrition supplement. Despite some promising effects, few randomized controlled trials have been conducted to study the effect of preoperative carbohydrate intake on quality of recovery in patients undergoing daytime oral surgery. In this study, we aimed to evaluate the effect of preoperative oral carbohydrate (Outfast) intake on the postoperative outcome and quality of recovery (QoR) of patients undergoing elective daytime oral surgery. The purpose of this study was to compare the QoR-15 questionnaire outcomes of patients undergoing daytime oral surgery. We hypothesize that preoperative oral carbohydrate intake could improve the postoperative recovery quality of patients undergoing daytime oral surgery. Methods Study design and Participants This study was approved by the Ethical Committee of The First Affiliated Hospital of Anhui Medical University, Hefei, China (Approval No. PJ2022-01-19) and registered in the Chinese Clinical Trial Registry ( www.chictr.org.cn ; ChiCTR2100053753) on 28/11/2021. All participants were from The First Affiliated Hospital of Anhui Medical University. Informed consent forms were signed by all participants. Patients aged 18 to 65 years with an American Society of Anesthesiologists (ASA) physical status of I–II and body mass index (BMI) of 18 to 30 kg/m 2 who were scheduled for day-stay oral–maxillofacial surgery were enrolled in this study between August 2022 and December 2022. Patients with the following conditions were excluded: type 1 or 2 diabetes and other endocrine system diseases, a gastric emptying disorder, psychical and psychological disease, hepatic or renal insufficiency, and inability to communicate. Exit criteria were as follows: a procedure lasting less than 1 hour or more than 3 hours, the occurrence of severe adverse events during operation, and patients’ refusal to follow-up. The specific aims of the study were to 1) evaluate the QoR-15 questionnaire outcomes and 2) compare the patient well-being and satisfaction with or without Outfast drink 2–3 hours before the induction of anesthesia. Randomization The patients were randomly divided into two groups using a random number generator website ( https://www.powerandsamplesize.com/ ) in a 1:1 ratio and either administered the preoperative oral carbohydrate Outfast (O group, Yichang Humanwell FSMP CO., LTD, Yichang, China) or made to fast before surgery (F group). In the afternoon of the day before surgery, a study coordinator independent of the clinical team from the hospitals opened the numbered, opaque, and sealed randomization envelopes and managed participants according to the group allocation. Participants in the F group fasted from midnight the day before surgery. Participants in the O group also fasted but received Outfast (4 ml/kg) 2–3 hours before the induction of anesthesia. A same nurse not involved in the study provided patient education which included the day surgery process, surgical precautions, postoperative rehabilitation plan, and psychological care. Clinical protocol Once the patient entered the operating room, an intravenous line was placed. Sodium lactate Ringer’s injection was infused at 6–8 ml/kg before the induction of anesthesia and at a rate of 5–7 ml/kg/h during the surgery. Peripheral capillary oxygen saturation (SpO 2 ), non-invasive blood pressure, electrocardiography (ECG), and bispectral index (BIS) were monitored. Anesthesia was induced with sufentanil (0.3–0.4 µg/kg), propofol (1.5–2.5 mg/kg)/etomidate (0.2–0.3 mg/kg), and cisatracurium (0.2–0.4 mg/kg). After endotracheal intubation, mechanical ventilation with tidal volumes of 8–10 ml/kg and a respiratory rate of 10–12/min was undertaken. Anesthesia was maintained with propofol (4–6 mg/kg/h), remifentanil (0.1–0.2 µg/kg/min), sufentanil (5–10 µg), and cisatracurium (0.2 mg/kg). BIS values were adjusted to 40–60. End-tidal carbon dioxide concentration (EtCO2) was maintained at 35–45 mmHg. Heart rate (HR) was controlled between 50 and 90 beats/min, and circulatory dynamics were maintained at ± 20% of preoperative blood pressure. At the end of the surgery, flurbiprofen axetil (50 mg) was given for pain relief. Outcomes In this study, the primary outcome was the QoR-15 score. The QoR-15 ranges from 0 (the poorest quality of recovery) to 150 (the best quality of recovery) and is widely used to assess postoperative recovery. It has 15 items that evaluate five dimensions: physical comfort (five items), emotional state (four items), physical independence (two items), psychological support (two items), and pain (two items) [9]. The QoR-15 was measured before anesthesia induction and 24 hours after surgery. Secondary outcomes included the assessment of patient well-being and satisfaction, which were measured before anesthesia induction and 24 hours after surgery. Seven parameters representing patient well-being (thirst, hunger, mouth dryness, nausea and vomiting, fatigue, anxiety, and sleep quality) were evaluated with a numeric rating scale (NRS; 0: no discomfort, 10: worst imaginable discomfort) [10]. Patient satisfaction was assessed via a 5-point scale (5: very satisfied, 4: somewhat satisfied, 3: neutral, 2: somewhat dissatisfied, 1: very dissatisfied) [11]. Heterogenous predictor variables included demographic variables and perioperative variables, such as age, gender male(M)/female(F), height, weight, ASA I/II, type of surgery, duration of anesthesia, duration of surgery, dose of propofol, dose of remifentanil, fluid volume, fasting time, hospital length of stay, postoperative exhaust time, and adverse events (defined as aspiration, readmission, return to the operating room, increased length of stay due to medical necessity). We also recorded mean arterial pressure (MAP) and HR at the following time points: before anesthesia (T0), 5 min after endotracheal intubation (T1), surgery finish (T2), and tracheal extubation (T3). Blood glucose concentrations were tested at baseline level, anesthesia induction (Ta), surgery finish (Tb), and postanesthesia care unit (PACU) discharge (Tc), respectively. Sample size Previous study recommended that the minimal clinically important difference (MCID) for the QoR-15 scale was 6.0 with standard deviation (SD) ± 8.77 [12]. In our study, sample size calculation was performed with an online power sample size calculator ( https://www.powerandsamplesize.com/ ). A sample size of 45 patients in each group was estimated necessary to detect such a difference with a power of 90% and an α-error of 5% based on the results of our pilot study (σ = 8.77). Considering potential dropouts and incomplete follow-up, a total of 102 patients were finally enrolled. Statistical analysis All data were analyzed using SPSS version 25.0 (IBM Corporation, USA). The Shapiro-Wilk test was used to determine the normality of the data distribution. Continuous variables are summarized as mean (SD) or median (interquartile range [IQR]), as appropriate. Demographic and baseline data such as age, height, weight, duration of anesthesia, duration of surgery, dose of propofol, dose of remifentanil, fluid volume, fasting time, length of hospital stay, and postoperative exhaust time were compared using the Student t-test. Repeated measures ANOVA was used to compare differences in repeated measures of QoR-15 scores, well-being and satisfaction scores, blood glucose levels, MAP and HR between the two groups. When a statistically significant group effect was found, the LSD post hoc test was used to compare differences in the distributions of observed indicators between the two groups at different time points. The Chi-square test was used to examine the relationship between qualitative variables and independent samples (gender M/F, ASA I/II and type of surgery). A P value < 0.05 was considered statistically significant. Results A total of 102 patients were enrolled in this clinical trial. 10 patients were excluded from the study: 1 patient was suspected to have diabetes mellitus, 1 patient had surgery cancelled, 2 patients had an operation duration of longer than 3 hours (F group: n = 1, O group: n = 1), and 6 patients had an operation duration of less than 1 hour (F group: n = 4, O group: n = 2). Thus, 92 patients were included in the data analyses (F group: n = 45), O group: n = 47). The flow diagram of the study is shown in Fig. 1 . The demographic characteristics of the patients are presented in Table 1 . There were no statistically significant differences between the two groups in terms of age, gender, body weight, height, and ASA classification. The perioperative profiles of the patients, such as type of surgery, duration of surgery and anesthesia, dose of propofol and remifentanil, fluid volume, fasting time, and length of hospital stay, were not significantly different between the two groups (Table 1 ). Compared with the F group, the postoperative exhaust time was significantly shorter in the O group ( P < 0.001, Table 1 ). Table 1 Patients characteristics and perioperative clinical data Variables F group( n = 45) O group( n = 47) P Age (year) 28.16 ± 7.42 29.15 ± 9.32 0.573 Gender (M/F) 20/25 19/28 0.697 Height (cm) 168.29 ± 8.36 168.06 ± 8.19 0.900 Weight (kg) 62.64 ± 11.73 61.43 ± 13.89 0.650 ASA (Ⅰ/Ⅱ) 13/32 12/35 0.717 Type of surgery 1.000 Extraction of impacted tooth 41 43 Other intraoral surgery 4 4 Duration of surgery (min) 84.31 ± 24.79 90.04 ± 26.55 0.287 Duration of anesthesia (min) 102.51 ± 24.34 106.09 ± 28.63 0.520 Dose of propofol (mg) 426.76 ± 142.09 436.95 ± 152.03 0.740 Dose of remifentanil (µg) 0.86 ± 0.27 0.92 ± 0.37 0.292 Fluid volume (ml) 431 ± 163.80 447.77 ± 176.70 0.638 Solid food fasting time (hour) 15.14 ± 3.53 16.53 ± 3.09 0.052 Hospital length of stay (hour) 24.27 ± 4.48 23.62 ± 3.52 0.443 Postoperative exhaust time (hour) 25.92 ± 8.26 17.06 ± 8.43 < 0.001 M: male; F: female; ASA: American Society of Anesthesiologists. The total QoR-15 scores in the O group were significantly higher than those in the F group preoperatively and postoperatively (Fig. 2 ). The satisfaction and well-being of patients are displayed in Table 2 . The NRS scores regarding thirst, hunger, mouth dryness, and anxiety were statistically significantly lower in the O group than in the F group preoperatively. The postoperative scores for thirst, mouth dryness, nausea and vomiting, fatigue and sleep quality were statistically significantly lower in the O group than in the F group. Compared with the F group, significantly higher satisfaction was observed in the O group based on the 5-point scale. Table 2 Assessment of patients’ perioperative well-being and satisfaction Preoperative well-being Median (IQR) P Postoperative well-being Median (IQR) P F group ( n = 45) O group ( n = 47) F group ( n = 45) O group ( n = 47) Thirst 5(3–7) 3(2–5) 0.002 3(2–5) 2(0–3) 0.002 Hunger 4(2–6) 3(1–5) 0.016 4(1.5-4) 2(0–4) 0.129 Mouth dryness 5(3–7) 3(2–5) 0.003 5(4–8) 2(0–4) < 0.001 Nausea and vomiting 0(0–0) 0(0–0) 0.095 0(0-0.5) 0(0–0) 0.026 Fatigue 0(0–2) 0(0–2) 0.326 3(2–4) 0(0–1) < 0.001 Anxiety 2(1–3) 0(0–2) 0.002 0(0–1) 0(0–0) 0.102 Sleep quality 2(0.5–6.5) 2(0–5) 0.103 3(2.5–5.5) 1(0–2) < 0.001 Patient satisfaction* 5(4–5) 5(5–5) 0.008 5(4–5) 5(5–5) 0.002 Seven parameters representing patient well-being (thirst, hunger, mouth dryness, nausea and vomiting, fatigue, anxiety, and sleep quality) were assessed using a numeric rating scale (0–10). *Patient satisfaction was measured by a 5-point scale (5: very satisfied, 4: somewhat satisfied, 3: neutral, 2: somewhat dissatisfied, 1: very dissatisfied). IQR: interquartile range. No statistically significant differences were found in the MAP and HR between F group and O group at each observing time points, i.e. T0, T1, T2 and T3 (Table 3 ). There were no significant differences in blood glucose concentration at baseline, Ta, Tb, and Tc between the two groups (Fig. 3 ). Table 3 Perioperative MAP and HR changes MAP (mmHg) P HR (beats/min) P F group ( n = 45) O group ( n = 47) F group ( n = 45) O group ( n = 47) T0 89.91 ± 12.32 84.68 ± 13.61 0.057 79.29 ± 12.09 79.74 ± 11.57 0.854 T1 77.78 ± 9.11 76.09 ± 11.15 0.429 65.80 ± 12.34 66.64 ± 10.16 0.722 T2 76.87 ± 10.09 76.17 ± 12.58 0.771 69.56 ± 10.58 68.30 ± 10.15 0.562 T3 91.00 ± 12.91 88.57 ± 12.18 0.356 86.04 ± 14.67 81.15 ± 9.53 0.060 MAP: mean arterial pressure; HR: heart rate. The indicated time points were as follows: T0: before anesthesia; T1: 5 min after endotracheal intubation; T2: surgery finish; T3: tracheal extubation No adverse events were reported in either group. Discussion The diseases treated via ambulatory surgery in oral and maxillofacial consisted mainly of impacted teeth, odontogenic cysts, and supernumerary teeth [13]. In these oral and maxillofacial surgery, due to the nature of the operation site, the time to first oral feeding is often postponed after surgery, which also affects their postoperative recovery. ERAS is an evidence-based care improvement process for surgical patients, which has been widely used in clinical practice. ERAS started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties. It can shorten length of hospital stay [5,14], improve the effectiveness and safety of the procedure [15], and reduce hospitalization costs [14]. Preoperative oral carbohydrate Intake, as a part of ERAS protocols, is recommended for patients in several kinds of surgery [16,17]. However, few studies have examined the effect of preoperative carbohydrate intake on patients undergoing daytime oral surgery. This study revealed that preoperative oral carbohydrate intake can increase QoR-15 scores, improve well-being and satisfaction, and accelerate the postoperative intestinal exhaust of patients. In this study, the preoperative and postoperative QoR-15 scores were statistically significantly improved with carbohydrate intake before surgery. However, there are still contradictions regarding the effect of preoperative oral carbohydrate intake on postoperative recovery in different studies [18–20]. In a study by Cho et al ., preoperative oral carbohydrate intake did not increase the QoR-15 scores significantly [19]. This may be explained by the different carbohydrate beverage intake time compared to our study. Additionally, all participants were infused with Ringer’s lactate solution from midnight until surgery in that study, which may have been sufficient for the enhanced postoperative recovery of patients. Our results were concurrent with a study by Wang et al ., which had a similar carbohydrate beverage intake time [18]. Thus, it is appropriate to consume a carbohydrate beverage 2–3 hours before the induction of anesthesia. The effects of preoperative carbohydrate intake on patient well-being and satisfaction were also examined. This study revealed that, compared with fasting group, preoperative oral carbohydrate intake could improve four out of seven patient well-being parameters (thirst, hunger, mouth dryness, and anxiety) before surgery and five out of seven parameters (thirst, mouth dryness, nausea and vomiting, fatigue, and sleep quality) postoperatively. Patients who received oral carbohydrates preoperatively also showed better satisfaction than patients fasting from midnight. In contrast to our data, Doo et al. reported no significant improvements in patient well-being and the satisfaction of patients undergoing thyroidectomy with preoperative carbohydrate intake [21]. However, their study only enrolled participants scheduled for surgery at 8:30 am. Patients were asleep for most of the fasting period and thus maintained a physiological state without feeling hunger or thirst. Therefore, our findings are suitable for most patients and are in accordance with previous reports [15,22–24]. Insulin resistance is a catabolic state involving the degradation of stored glycogen via glycogenolysis and muscle protein loss and lipolysis that subsequently leads to hyperglycemia and hyperinsulinemia. It is proportional to the length of fasting time and the intensity of surgical trauma and can prolong the recovery time, increase the incidence of postoperative wound infection, and even increase the mortality risk of surgical patients [20,23,24]. Carbohydrate-rich drinks are administrated preoperatively in more and more kinds of operations to reduce insulin resistance and maintain blood glucose homeostasis and thereby reduce the length of hospital stay [23,25]. In this study, the perioperative blood glucose levels of patients after preoperative carbohydrate intake were not significantly different compared to fasting patients. This result may be because the trauma intensity of daytime oral surgery is low and the participants undergoing daytime oral surgery are typically young and in good physical condition. Postoperative exhaust time is also an important indicator of ERAS [15]. In our study, the first postoperative exhaust time in patients with carbohydrate intake was significantly shorter compared to that of fasting patients. Previous studies also support our results, Lin et al. reported that the first anal exhaust time after laparoscopic radical prostatectomy in the ERAS group was significantly shorter compared with the control group [14]. A study by Zuo et al. also showed that the exhaust recovery time in the ERAS group was significantly shorter than in the non-ERAS group in patients with lumbar disc herniation after discectomy [26]. However, there are few studies about the effect of preoperative oral carbohydrate intake on the postoperative exhaust time; thus, we will investigate the effect of oral carbohydrate (Outfast) on the recovery of postoperative intestinal function in the future. This study has several limitations. First, perioperative insulin resistance was not measured in our study. With insulin resistance measurement, we would have stronger evidence to verify the effect of preoperative carbohydrate intake. Second, even though no aspiration occurred in this study, the study design would be more rigorous if gastric ultrasound was performed to estimate the gastric content volume. However, previous studies have shown that the moderate intake of oral carbohydrates 2 hours before anesthesia is safe for the preoperative management of fasting patients via ultrasonography [22,27]. Third, the absence of a placebo group in our study may undermine the robustness of our findings. Finally, only participants aged 18–65 years having ASA physical status grades I and II were enrolled in this study. It is necessary to explore the effect of preoperative oral carbohydrate intake on elderly patients or patients with higher ASA grades in future studies. Conclusions Preoperative carbohydrate intake 2–3 hours before anesthesia induction could improve the QoR-15 questionnaire scores 24 hours after surgery and increase the comfort of patients undergoing daytime oral surgery, which may serve as a treatment option for patients undergoing daytime oral surgery. Abbreviations QoR=quality of recovery; F=fasting; O=Outfast ; NRS=numeric rating scale; ERAS= enhanced recovery after surgery; ASA=American Society of Anesthesiologists; BMI=body mass index; SpO 2 =peripheral capillary oxygen saturation; ECG=electrocardiography; BIS=bispectral index; EtCO 2 =End-tidal carbon dioxide concentration; HR=heart rate; M=male; F=female; MAP=mean arterial pressure; SD=standard deviation; IQR=interquartile range; MCID=minimal clinically important difference; T0=before anesthesia; T1=5 min after endotracheal intubation, T2=surgery finish; T3=tracheal extubation; Ta=anesthesia induction; Tb=surgery finish ,PACU= postanesthesia care unit; Tc= PACU discharge. Declarations Ethics approval and consent to participate Ethical approval (Ethical Committee No. PJ2022-01-19) was provided by the ethics committee of the First Affiliated Hospital of Anhui Medical University in January 2022. All patients provided informed consent and all procedures were conducted according to the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding This work was funded by the research funding from the Anhui Medical University (2022xkj150). Authors' contributions Y.L. and W.Z. conceived and designed the experiments. W.T., G.M., C.Y. and Y.S. performed experiments and analyzed data. W.T. and G.M. drafted the manuscript. Y.L. and W.Z. revised the manuscript. All authors read and approved the final manuscript. Acknowledgements We thank Dr Yukun Hu, Dr Linfei Feng, Dr Jun Hou and Dr Jin Rao for help with patient recruitment. We thank Dr Lianjie Dou and Dr Chengyang Hu for their assistance in the statistical analysis. References Li L, Wang Z, Ying X, Tian J, Sun T, Yi K, Zhang P, Jing Z, Yang K. Preoperative carbohydrate loading for elective surgery: a systematic review and meta-analysis. Surg Today. 2012;42(7):613-24. He Y, Liu C, Han Y, Huang Y, Zhou J, Xie Q. The impact of oral carbohydrate-rich supplement taken two hours before caesarean delivery on maternal and neonatal perioperative outcomes -- a randomized clinical trial. BMC Pregnancy Childbirth. 2021;21(1):682. Wu HY, Yang XD, Yang GY, Cai ZG, Shan XF, Yang Y. Preoperative oral carbohydrates in elderly patients undergoing free flap surgery for oral cancer: randomized controlled trial. Int J Oral Maxillofac Surg. 2022;51(8):1010-5. McCracken GC, Montgomery J. 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Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Oct, 2024 Read the published version in Perioperative Medicine → Version 1 posted Editorial decision: Revision requested 13 Sep, 2024 Reviews received at journal 04 Sep, 2024 Reviewers agreed at journal 04 Sep, 2024 Reviewers invited by journal 04 Sep, 2024 Editor assigned by journal 23 Aug, 2024 Submission checks completed at journal 23 Aug, 2024 First submitted to journal 21 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4954722","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":353706571,"identity":"e3dfef62-46c2-42c1-a44f-6aba0720a930","order_by":0,"name":"Weixiang Tang","email":"","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Weixiang","middleName":"","lastName":"Tang","suffix":""},{"id":353706573,"identity":"bc3a855b-35ff-4a06-a694-dd3c0cf1b9d9","order_by":1,"name":"Gaige Meng","email":"","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Gaige","middleName":"","lastName":"Meng","suffix":""},{"id":353706574,"identity":"78d4d2db-c81d-47cb-848e-1ca00e047e91","order_by":2,"name":"Chen Yang","email":"","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"Yang","suffix":""},{"id":353706575,"identity":"35e84efb-20e9-498c-a73b-ba4b4273f15e","order_by":3,"name":"Yue Sun","email":"","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yue","middleName":"","lastName":"Sun","suffix":""},{"id":353706576,"identity":"c48f3fa9-2bdd-49e7-97ca-630f99d15e26","order_by":4,"name":"Weiwei Zhong","email":"","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Weiwei","middleName":"","lastName":"Zhong","suffix":""},{"id":353706577,"identity":"4d5886f2-8e3f-459c-a42c-b8e8f3ec4b2d","order_by":5,"name":"Yao Lu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYBACPjBZwZAApnmI0cIGJs+QrIWxjSQtEjmGHz7Os8vTnZHA+OBtG4O8ORFajCVnbksuNruRwGw4t43BcGcDYS0G0rzbmBO33Uhgk+YFutDgABG2/OadUw/Swv6bWC1m0rwNh8G2MBOnhedZmeWMY8cTt5152Cw555yE4QZCWvjZkzff+FBTnbjtePLBD2/KbOQJ2sLAwGEAZTA2AAkJguqBgP0BMapGwSgYBaNgJAMAo0M9AqtytTYAAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yao","middleName":"","lastName":"Lu","suffix":""}],"badges":[],"createdAt":"2024-08-22 03:14:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4954722/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4954722/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13741-024-00459-8","type":"published","date":"2024-10-14T15:57:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66756455,"identity":"30fde6e7-748f-46ab-b566-4f6f1196ff95","added_by":"auto","created_at":"2024-10-16 08:21:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1305481,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow diagram of day-stay oral–maxillofacial patients.\u003c/p\u003e","description":"","filename":"Fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-4954722/v1/3f8e579ad13df75f37ef3d9f.png"},{"id":66756457,"identity":"2eb00468-3daa-47cb-9e46-d50f13567b2e","added_by":"auto","created_at":"2024-10-16 08:21:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38425,"visible":true,"origin":"","legend":"\u003cp\u003ePerioperative changes of QoR-15 score according to groups.\u003c/p\u003e\n\u003cp\u003eQoR-15: 15-item quality of recovery score; pre-op: preoperative QoR-15 score; post-op: postoperative QoR-15 score. * \u003cem\u003eP \u003c/em\u003e\u0026lt; 0.05. *** \u003cem\u003eP \u003c/em\u003e\u0026lt; 0.001.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4954722/v1/e99c2dd8f5c8a4e5a915ca72.png"},{"id":66756456,"identity":"b43b8a5c-4c05-4ea7-8c90-e88ab6fb78c9","added_by":"auto","created_at":"2024-10-16 08:21:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":74620,"visible":true,"origin":"","legend":"\u003cp\u003ePerioperative changes in blood glucose according to groups.\u003c/p\u003e\n\u003cp\u003ens: no significant difference. The indicated time points were as follows: Baseline: fasting blood glucose; Ta: anesthesia induction, Tb: surgery finish; Tc: PACU discharge.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4954722/v1/28c19ce9d34b72ec3884f65f.png"},{"id":67148910,"identity":"f355ba64-6e05-4515-8657-407a2fa2874c","added_by":"auto","created_at":"2024-10-21 16:09:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2013803,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4954722/v1/2c4c0100-9817-49ec-a75d-682f56c0d845.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of preoperative oral carbohydrate on the postoperative recovery quality of patients undergoing daytime oral surgery: a randomized controlled trial","fulltext":[{"header":"Background","content":"\u003cp\u003eFasting from midnight before surgery is a standard practice among patients undergoing elective surgery to reduce the risk of pulmonary aspiration under anesthesia [1]. However, accumulated evidence revealed that midnight fasting does not decrease the volume and acidity of stomach content related to perioperative complications [2]. Conversely, long-term fasting could lead to insulin resistance and postoperative discomforts such as thirst, hunger, and anxiety [2\u0026ndash;4], which has an association with prolonged length of hospital stay. Additionally, as patients receiving daytime oral surgery often have difficulty opening the mouth and chewing after the operation, the fasting time is even longer. As a result, excessive fasting may reduce the quality of postoperative recovery of patients undergoing daytime oral surgery.\u003c/p\u003e \u003cp\u003ePreoperative carbohydrate intake is implemented as part of enhanced recovery after surgery (ERAS) and has been shown to alleviate some of the discomforts associated with fasting during the perioperative period [5]. However, certain studies suggest that preoperative carbohydrate intake may not significantly improve postoperative recovery or have a minimal effect. The variability in results could be attributed to inadequate blinding and differences in patient populations. [6\u0026ndash;8]. Outfast is a kind of carbohydrate (osmotic pressure 280\u0026ndash;300 mmol/L, pH 3.8\u0026ndash;4.3, contents per 100 ml: 14.2 g carbohydrate, 45 mg sodium, 0.24 mg vitamin B1, 0.13 mg vitamin B6, 0.14 mg vitamin B12, and 1.48 mg zinc) used for the perioperative fasting of patients under general anesthesia to provide energy and a nutrition supplement. Despite some promising effects, few randomized controlled trials have been conducted to study the effect of preoperative carbohydrate intake on quality of recovery in patients undergoing daytime oral surgery.\u003c/p\u003e \u003cp\u003eIn this study, we aimed to evaluate the effect of preoperative oral carbohydrate (Outfast) intake on the postoperative outcome and quality of recovery (QoR) of patients undergoing elective daytime oral surgery. The purpose of this study was to compare the QoR-15 questionnaire outcomes of patients undergoing daytime oral surgery. We hypothesize that preoperative oral carbohydrate intake could improve the postoperative recovery quality of patients undergoing daytime oral surgery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design and Participants\u003c/h2\u003e\n \u003cp\u003eThis study was approved by the Ethical Committee of The First Affiliated Hospital of Anhui Medical University, Hefei, China (Approval No. PJ2022-01-19) and registered in the Chinese Clinical Trial Registry (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.chictr.org.cn\u003c/span\u003e\u003c/span\u003e; ChiCTR2100053753) on 28/11/2021. All participants were from The First Affiliated Hospital of Anhui Medical University. Informed consent forms were signed by all participants. Patients aged 18 to 65 years with an American Society of Anesthesiologists (ASA) physical status of I\u0026ndash;II and body mass index (BMI) of 18 to 30 kg/m\u003csup\u003e2\u003c/sup\u003e who were scheduled for day-stay oral\u0026ndash;maxillofacial surgery were enrolled in this study between August 2022 and December 2022. Patients with the following conditions were excluded: type 1 or 2 diabetes and other endocrine system diseases, a gastric emptying disorder, psychical and psychological disease, hepatic or renal insufficiency, and inability to communicate. Exit criteria were as follows: a procedure lasting less than 1 hour or more than 3 hours, the occurrence of severe adverse events during operation, and patients\u0026rsquo; refusal to follow-up. The specific aims of the study were to 1) evaluate the QoR-15 questionnaire outcomes and 2) compare the patient well-being and satisfaction with or without Outfast drink 2\u0026ndash;3 hours before the induction of anesthesia.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eRandomization\u003c/h2\u003e\n \u003cp\u003eThe patients were randomly divided into two groups using a random number generator website (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.powerandsamplesize.com/\u003c/span\u003e\u003c/span\u003e) in a 1:1 ratio and either administered the preoperative oral carbohydrate Outfast (O group, Yichang Humanwell FSMP CO., LTD, Yichang, China) or made to fast before surgery (F group). In the afternoon of the day before surgery, a study coordinator independent of the clinical team from the hospitals opened the numbered, opaque, and sealed randomization envelopes and managed participants according to the group allocation. Participants in the F group fasted from midnight the day before surgery. Participants in the O group also fasted but received Outfast (4 ml/kg) 2\u0026ndash;3 hours before the induction of anesthesia. A same nurse not involved in the study provided patient education which included the day surgery process, surgical precautions, postoperative rehabilitation plan, and psychological care.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eClinical protocol\u003c/h2\u003e\n \u003cp\u003eOnce the patient entered the operating room, an intravenous line was placed. Sodium lactate Ringer\u0026rsquo;s injection was infused at 6\u0026ndash;8 ml/kg before the induction of anesthesia and at a rate of 5\u0026ndash;7 ml/kg/h during the surgery. Peripheral capillary oxygen saturation (SpO\u003csub\u003e2\u003c/sub\u003e), non-invasive blood pressure, electrocardiography (ECG), and bispectral index (BIS) were monitored. Anesthesia was induced with sufentanil (0.3\u0026ndash;0.4 \u0026micro;g/kg), propofol (1.5\u0026ndash;2.5 mg/kg)/etomidate (0.2\u0026ndash;0.3 mg/kg), and cisatracurium (0.2\u0026ndash;0.4 mg/kg). After endotracheal intubation, mechanical ventilation with tidal volumes of 8\u0026ndash;10 ml/kg and a respiratory rate of 10\u0026ndash;12/min was undertaken. Anesthesia was maintained with propofol (4\u0026ndash;6 mg/kg/h), remifentanil (0.1\u0026ndash;0.2 \u0026micro;g/kg/min), sufentanil (5\u0026ndash;10 \u0026micro;g), and cisatracurium (0.2 mg/kg). BIS values were adjusted to 40\u0026ndash;60. End-tidal carbon dioxide concentration (EtCO2) was maintained at 35\u0026ndash;45 mmHg. Heart rate (HR) was controlled between 50 and 90 beats/min, and circulatory dynamics were maintained at \u0026plusmn;\u0026thinsp;20% of preoperative blood pressure. At the end of the surgery, flurbiprofen axetil (50 mg) was given for pain relief.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eOutcomes\u003c/h2\u003e\n \u003cp\u003eIn this study, the primary outcome was the QoR-15 score. The QoR-15 ranges from 0 (the poorest quality of recovery) to 150 (the best quality of recovery) and is widely used to assess postoperative recovery. It has 15 items that evaluate five dimensions: physical comfort (five items), emotional state (four items), physical independence (two items), psychological support (two items), and pain (two items) [9]. The QoR-15 was measured before anesthesia induction and 24 hours after surgery.\u003c/p\u003e\n \u003cp\u003eSecondary outcomes included the assessment of patient well-being and satisfaction, which were measured before anesthesia induction and 24 hours after surgery. Seven parameters representing patient well-being (thirst, hunger, mouth dryness, nausea and vomiting, fatigue, anxiety, and sleep quality) were evaluated with a numeric rating scale (NRS; 0: no discomfort, 10: worst imaginable discomfort) [10]. Patient satisfaction was assessed via a 5-point scale (5: very satisfied, 4: somewhat satisfied, 3: neutral, 2: somewhat dissatisfied, 1: very dissatisfied) [11].\u003c/p\u003e\n \u003cp\u003eHeterogenous predictor variables included demographic variables and perioperative variables, such as age, gender male(M)/female(F), height, weight, ASA I/II, type of surgery, duration of anesthesia, duration of surgery, dose of propofol, dose of remifentanil, fluid volume, fasting time, hospital length of stay, postoperative exhaust time, and adverse events (defined as aspiration, readmission, return to the operating room, increased length of stay due to medical necessity). We also recorded mean arterial pressure (MAP) and HR at the following time points: before anesthesia (T0), 5 min after endotracheal intubation (T1), surgery finish (T2), and tracheal extubation (T3). Blood glucose concentrations were tested at baseline level, anesthesia induction (Ta), surgery finish (Tb), and postanesthesia care unit (PACU) discharge (Tc), respectively.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eSample size\u003c/h2\u003e\n \u003cp\u003ePrevious study recommended that the minimal clinically important difference (MCID) for the QoR-15 scale was 6.0 with standard deviation (SD)\u0026thinsp;\u0026plusmn;\u0026thinsp;8.77 [12]. In our study, sample size calculation was performed with an online power sample size calculator (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.powerandsamplesize.com/\u003c/span\u003e\u003c/span\u003e). A sample size of 45 patients in each group was estimated necessary to detect such a difference with a power of 90% and an \u0026alpha;-error of 5% based on the results of our pilot study (\u0026sigma;\u0026thinsp;=\u0026thinsp;8.77). Considering potential dropouts and incomplete follow-up, a total of 102 patients were finally enrolled.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eAll data were analyzed using SPSS version 25.0 (IBM Corporation, USA). The Shapiro-Wilk test was used to determine the normality of the data distribution. Continuous variables are summarized as mean (SD) or median (interquartile range [IQR]), as appropriate. Demographic and baseline data such as age, height, weight, duration of anesthesia, duration of surgery, dose of propofol, dose of remifentanil, fluid volume, fasting time, length of hospital stay, and postoperative exhaust time were compared using the Student t-test. Repeated measures ANOVA was used to compare differences in repeated measures of QoR-15 scores, well-being and satisfaction scores, blood glucose levels, MAP and HR between the two groups. When a statistically significant group effect was found, the LSD post hoc test was used to compare differences in the distributions of observed indicators between the two groups at different time points. The Chi-square test was used to examine the relationship between qualitative variables and independent samples (gender M/F, ASA I/II and type of surgery). A \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 102 patients were enrolled in this clinical trial. 10 patients were excluded from the study: 1 patient was suspected to have diabetes mellitus, 1 patient had surgery cancelled, 2 patients had an operation duration of longer than 3 hours (F group: n\u0026thinsp;=\u0026thinsp;1, O group: n\u0026thinsp;=\u0026thinsp;1), and 6 patients had an operation duration of less than 1 hour (F group: n\u0026thinsp;=\u0026thinsp;4, O group: n\u0026thinsp;=\u0026thinsp;2). Thus, 92 patients were included in the data analyses (F group: \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;45), O group: \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;47). The flow diagram of the study is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe demographic characteristics of the patients are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were no statistically significant differences between the two groups in terms of age, gender, body weight, height, and ASA classification. The perioperative profiles of the patients, such as type of surgery, duration of surgery and anesthesia, dose of propofol and remifentanil, fluid volume, fasting time, and length of hospital stay, were not significantly different between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Compared with the F group, the postoperative exhaust time was significantly shorter in the O group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients characteristics and perioperative clinical data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF group(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eO group(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.16\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.15\u0026thinsp;\u0026plusmn;\u0026thinsp;9.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (M/F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20/25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19/28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168.29\u0026thinsp;\u0026plusmn;\u0026thinsp;8.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e168.06\u0026thinsp;\u0026plusmn;\u0026thinsp;8.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.64\u0026thinsp;\u0026plusmn;\u0026thinsp;11.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.43\u0026thinsp;\u0026plusmn;\u0026thinsp;13.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.650\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA (Ⅰ/Ⅱ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13/32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12/35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtraction of impacted tooth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther intraoral surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of surgery (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84.31\u0026thinsp;\u0026plusmn;\u0026thinsp;24.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.04\u0026thinsp;\u0026plusmn;\u0026thinsp;26.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of anesthesia (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102.51\u0026thinsp;\u0026plusmn;\u0026thinsp;24.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106.09\u0026thinsp;\u0026plusmn;\u0026thinsp;28.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDose of propofol (mg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e426.76\u0026thinsp;\u0026plusmn;\u0026thinsp;142.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e436.95\u0026thinsp;\u0026plusmn;\u0026thinsp;152.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDose of remifentanil (\u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFluid volume (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e431\u0026thinsp;\u0026plusmn;\u0026thinsp;163.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e447.77\u0026thinsp;\u0026plusmn;\u0026thinsp;176.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSolid food fasting time (hour)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital length of stay (hour)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.62\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative exhaust time (hour)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.06\u0026thinsp;\u0026plusmn;\u0026thinsp;8.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eM: male; F: female; ASA: American Society of Anesthesiologists.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe total QoR-15 scores in the O group were significantly higher than those in the F group preoperatively and postoperatively (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The satisfaction and well-being of patients are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The NRS scores regarding thirst, hunger, mouth dryness, and anxiety were statistically significantly lower in the O group than in the F group preoperatively. The postoperative scores for thirst, mouth dryness, nausea and vomiting, fatigue and sleep quality were statistically significantly lower in the O group than in the F group. Compared with the F group, significantly higher satisfaction was observed in the O group based on the 5-point scale.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssessment of patients\u0026rsquo; perioperative well-being and satisfaction\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003cp\u003ewell-being\u003c/p\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003ewell-being\u003c/p\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eO group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eO group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(3\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHunger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(2\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(1.5-4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMouth dryness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(3\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(4\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea and vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0\u0026ndash;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0\u0026ndash;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0-0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0\u0026ndash;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(1\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0\u0026ndash;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(0.5\u0026ndash;6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(0\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(2.5\u0026ndash;5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient satisfaction*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(5\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(5\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eSeven parameters representing patient well-being (thirst, hunger, mouth dryness, nausea and vomiting, fatigue, anxiety, and sleep quality) were assessed using a numeric rating scale (0\u0026ndash;10). *Patient satisfaction was measured by a 5-point scale (5: very satisfied, 4: somewhat satisfied, 3: neutral, 2: somewhat dissatisfied, 1: very dissatisfied). IQR: interquartile range.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNo statistically significant differences were found in the MAP and HR between F group and O group at each observing time points, i.e. T0, T1, T2 and T3 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There were no significant differences in blood glucose concentration at baseline, Ta, Tb, and Tc between the two groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative MAP and HR changes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMAP (mmHg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eHR (beats/min)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF group\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eO group\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF group\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eO group\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e89.91\u0026thinsp;\u0026plusmn;\u0026thinsp;12.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e84.68\u0026thinsp;\u0026plusmn;\u0026thinsp;13.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e79.29\u0026thinsp;\u0026plusmn;\u0026thinsp;12.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e79.74\u0026thinsp;\u0026plusmn;\u0026thinsp;11.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e77.78\u0026thinsp;\u0026plusmn;\u0026thinsp;9.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e76.09\u0026thinsp;\u0026plusmn;\u0026thinsp;11.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e65.80\u0026thinsp;\u0026plusmn;\u0026thinsp;12.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e66.64\u0026thinsp;\u0026plusmn;\u0026thinsp;10.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e76.87\u0026thinsp;\u0026plusmn;\u0026thinsp;10.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e76.17\u0026thinsp;\u0026plusmn;\u0026thinsp;12.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e69.56\u0026thinsp;\u0026plusmn;\u0026thinsp;10.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e68.30\u0026thinsp;\u0026plusmn;\u0026thinsp;10.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e91.00\u0026thinsp;\u0026plusmn;\u0026thinsp;12.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e88.57\u0026thinsp;\u0026plusmn;\u0026thinsp;12.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e86.04\u0026thinsp;\u0026plusmn;\u0026thinsp;14.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e81.15\u0026thinsp;\u0026plusmn;\u0026thinsp;9.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eMAP: mean arterial pressure; HR: heart rate. The indicated time points were as follows: T0: before anesthesia; T1: 5 min after endotracheal intubation; T2: surgery finish; T3: tracheal extubation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNo adverse events were reported in either group.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe diseases treated via ambulatory surgery in oral and maxillofacial consisted mainly of impacted teeth, odontogenic cysts, and supernumerary teeth [13]. In these oral and maxillofacial surgery, due to the nature of the operation site, the time to first oral feeding is often postponed after surgery, which also affects their postoperative recovery. ERAS is an evidence-based care improvement process for surgical patients, which has been widely used in clinical practice. ERAS started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties. It can shorten length of hospital stay [5,14], improve the effectiveness and safety of the procedure [15], and reduce hospitalization costs [14]. Preoperative oral carbohydrate Intake, as a part of ERAS protocols, is recommended for patients in several kinds of surgery [16,17]. However, few studies have examined the effect of preoperative carbohydrate intake on patients undergoing daytime oral surgery. This study revealed that preoperative oral carbohydrate intake can increase QoR-15 scores, improve well-being and satisfaction, and accelerate the postoperative intestinal exhaust of patients.\u003c/p\u003e \u003cp\u003eIn this study, the preoperative and postoperative QoR-15 scores were statistically significantly improved with carbohydrate intake before surgery. However, there are still contradictions regarding the effect of preoperative oral carbohydrate intake on postoperative recovery in different studies [18\u0026ndash;20]. In a study by Cho \u003cem\u003eet al\u003c/em\u003e., preoperative oral carbohydrate intake did not increase the QoR-15 scores significantly [19]. This may be explained by the different carbohydrate beverage intake time compared to our study. Additionally, all participants were infused with Ringer\u0026rsquo;s lactate solution from midnight until surgery in that study, which may have been sufficient for the enhanced postoperative recovery of patients. Our results were concurrent with a study by Wang \u003cem\u003eet al\u003c/em\u003e., which had a similar carbohydrate beverage intake time [18]. Thus, it is appropriate to consume a carbohydrate beverage 2\u0026ndash;3 hours before the induction of anesthesia.\u003c/p\u003e \u003cp\u003eThe effects of preoperative carbohydrate intake on patient well-being and satisfaction were also examined. This study revealed that, compared with fasting group, preoperative oral carbohydrate intake could improve four out of seven patient well-being parameters (thirst, hunger, mouth dryness, and anxiety) before surgery and five out of seven parameters (thirst, mouth dryness, nausea and vomiting, fatigue, and sleep quality) postoperatively. Patients who received oral carbohydrates preoperatively also showed better satisfaction than patients fasting from midnight. In contrast to our data, Doo \u003cem\u003eet al.\u003c/em\u003e reported no significant improvements in patient well-being and the satisfaction of patients undergoing thyroidectomy with preoperative carbohydrate intake [21]. However, their study only enrolled participants scheduled for surgery at 8:30 am. Patients were asleep for most of the fasting period and thus maintained a physiological state without feeling hunger or thirst. Therefore, our findings are suitable for most patients and are in accordance with previous reports [15,22\u0026ndash;24].\u003c/p\u003e \u003cp\u003eInsulin resistance is a catabolic state involving the degradation of stored glycogen via glycogenolysis and muscle protein loss and lipolysis that subsequently leads to hyperglycemia and hyperinsulinemia. It is proportional to the length of fasting time and the intensity of surgical trauma and can prolong the recovery time, increase the incidence of postoperative wound infection, and even increase the mortality risk of surgical patients [20,23,24]. Carbohydrate-rich drinks are administrated preoperatively in more and more kinds of operations to reduce insulin resistance and maintain blood glucose homeostasis and thereby reduce the length of hospital stay [23,25]. In this study, the perioperative blood glucose levels of patients after preoperative carbohydrate intake were not significantly different compared to fasting patients. This result may be because the trauma intensity of daytime oral surgery is low and the participants undergoing daytime oral surgery are typically young and in good physical condition.\u003c/p\u003e \u003cp\u003ePostoperative exhaust time is also an important indicator of ERAS [15]. In our study, the first postoperative exhaust time in patients with carbohydrate intake was significantly shorter compared to that of fasting patients. Previous studies also support our results, Lin \u003cem\u003eet al.\u003c/em\u003e reported that the first anal exhaust time after laparoscopic radical prostatectomy in the ERAS group was significantly shorter compared with the control group [14]. A study by Zuo \u003cem\u003eet al.\u003c/em\u003e also showed that the exhaust recovery time in the ERAS group was significantly shorter than in the non-ERAS group in patients with lumbar disc herniation after discectomy [26]. However, there are few studies about the effect of preoperative oral carbohydrate intake on the postoperative exhaust time; thus, we will investigate the effect of oral carbohydrate (Outfast) on the recovery of postoperative intestinal function in the future.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, perioperative insulin resistance was not measured in our study. With insulin resistance measurement, we would have stronger evidence to verify the effect of preoperative carbohydrate intake. Second, even though no aspiration occurred in this study, the study design would be more rigorous if gastric ultrasound was performed to estimate the gastric content volume. However, previous studies have shown that the moderate intake of oral carbohydrates 2 hours before anesthesia is safe for the preoperative management of fasting patients via ultrasonography [22,27]. Third, the absence of a placebo group in our study may undermine the robustness of our findings. Finally, only participants aged 18\u0026ndash;65 years having ASA physical status grades I and II were enrolled in this study. It is necessary to explore the effect of preoperative oral carbohydrate intake on elderly patients or patients with higher ASA grades in future studies.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003ePreoperative carbohydrate intake 2\u0026ndash;3 hours before anesthesia induction could improve the QoR-15 questionnaire scores 24 hours after surgery and increase the comfort of patients undergoing daytime oral surgery, which may serve as a treatment option for patients undergoing daytime oral surgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eQoR=quality of recovery; F=fasting; O=Outfast ; NRS=numeric rating scale; ERAS= enhanced recovery after surgery; ASA=American Society of Anesthesiologists; BMI=body mass index; SpO\u003csub\u003e2\u003c/sub\u003e=peripheral capillary oxygen saturation; ECG=electrocardiography; BIS=bispectral index; EtCO\u003csub\u003e2\u003c/sub\u003e=End-tidal carbon dioxide concentration; HR=heart rate; M=male; F=female; MAP=mean arterial pressure; SD=standard deviation; IQR=interquartile range; MCID=minimal clinically important difference; T0=before anesthesia; T1=5 min after endotracheal intubation, T2=surgery finish; T3=tracheal extubation; Ta=anesthesia induction; Tb=surgery finish ,PACU= postanesthesia care unit; Tc= PACU discharge.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eapproval (Ethical Committee No. PJ2022-01-19)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ewas provided by the ethics committee of the First Affiliated Hospital of Anhui Medical University in January\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e2022. All patients provided informed consent\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eand all procedures were conducted according to\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ethe Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the research funding from the Anhui Medical University (2022xkj150).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.L. and W.Z. conceived and designed the experiments. W.T., G.M., C.Y. and Y.S. performed experiments and analyzed data. W.T. and G.M. drafted the manuscript. Y.L. and W.Z. revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Dr Yukun Hu, Dr Linfei Feng, Dr Jun Hou and Dr Jin Rao for help with patient recruitment. We thank Dr Lianjie Dou and Dr Chengyang Hu for their assistance in the statistical analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLi L, Wang Z, Ying X, Tian J, Sun T, Yi K, Zhang P, Jing Z, Yang K. Preoperative carbohydrate loading for elective surgery: a systematic review and meta-analysis. Surg Today. 2012;42(7):613-24. \u003c/li\u003e\n\u003cli\u003eHe Y, Liu C, Han Y, Huang Y, Zhou J, Xie Q. The impact of oral carbohydrate-rich supplement taken two hours before caesarean delivery on maternal and neonatal perioperative outcomes -- a randomized clinical trial. BMC Pregnancy Childbirth. 2021;21(1):682. \u003c/li\u003e\n\u003cli\u003eWu HY, Yang XD, Yang GY, Cai ZG, Shan XF, Yang Y. Preoperative oral carbohydrates in elderly patients undergoing free flap surgery for oral cancer: randomized controlled trial. Int J Oral Maxillofac Surg. 2022;51(8):1010-5. \u003c/li\u003e\n\u003cli\u003eMcCracken GC, Montgomery J. Postoperative nausea and vomiting after unrestricted clear fluids before day surgery: A retrospective analysis. Eur J Anaesthesiol. 2018;35(5):337-42. \u003c/li\u003e\n\u003cli\u003eLjungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017;152(3):292-8. \u003c/li\u003e\n\u003cli\u003eAsakura A, Mihara T, Goto T. The Effect of Preoperative Oral Carbohydrate or Oral Rehydration Solution on Postoperative Quality of Recovery: A Randomized, Controlled Clinical Trial. PLoS One. 2015; 10(8):e0133309.\u003c/li\u003e\n\u003cli\u003eLee JS, Song Y, Kim JY, Park JS, Yoon DS. Effects of Preoperative Oral Carbohydrates on Quality of Recovery in Laparoscopic Cholecystectomy: A Randomized, Double Blind, Placebo-Controlled Trial. World J Surg. 2018;42(10):3150-7. \u003c/li\u003e\n\u003cli\u003eSmith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev. 2014;2014(8):CD009161.\u003c/li\u003e\n\u003cli\u003eStark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology. 2013;118(6):1332-40. \u003c/li\u003e\n\u003cli\u003eSada F, Krasniqi A, Hamza A, Gecaj-Gashi A, Bicaj B, Kavaja F. A randomized trial of preoperative oral carbohydrates in abdominal surgery. BMC Anesthesiol. 2014;14:93. \u003c/li\u003e\n\u003cli\u003eBopp C, Hofer S, Klein A, Weigand MA, Martin E, Gust R. A liberal preoperative fasting regimen improves patient comfort and satisfaction with anesthesia care in day-stay minor surgery. Minerva Anestesiol. 2011;77(7):680-6. \u003c/li\u003e\n\u003cli\u003eMyles PS, Myles DB. An Updated Minimal Clinically Important Difference for the QoR-15 Scale. Anesthesiology. 2021;135(5):934-5. \u003c/li\u003e\n\u003cli\u003eWang H, Chi Y, Huang H, Yang M, Li T, Lu Y, Hou J. Analysis of the disease constituent ratio and prognosis of patients undergoing ambulatory surgery in oral and maxillofacial medicine: A monocentric retrospective analysis of 427 patients. J Stomatol Oral Maxillofac Surg. 2023;124(1):101266. \u003c/li\u003e\n\u003cli\u003eLin C, Wan F, Lu Y, Li G, Yu L, Wang M. Enhanced recovery after surgery protocol for prostate cancer patients undergoing laparoscopic radical prostatectomy. J Int Med Res. 2019;47(1):114-21. \u003c/li\u003e\n\u003cli\u003eWu X, Liu L, Zhou F. Meta-analysis for the evaluation of perioperative enhanced recovery after gynaecological surgery. Ginekol Pol. 2022;93(11):896-903. \u003c/li\u003e\n\u003cli\u003eCheng PL, Loh EW, Chen JT, Tam KW. Effects of preoperative oral carbohydrate on postoperative discomfort in patients undergoing elective surgery: a meta-analysis of randomized controlled trials. Langenbecks Arch Surg. 2021;406(4):993-1005. \u003c/li\u003e\n\u003cli\u003eZhou W, Luo L. Preoperative prolonged fasting causes severe metabolic acidosis: A case report. Medicine (Baltimore). 2019;98(41):e17434. \u003c/li\u003e\n\u003cli\u003eWang S, Gao PF, Guo X, Xu Q, Zhang YF, Wang GQ, Lin JY. Effect of low-concentration carbohydrate on patient-centered quality of recovery in patients undergoing thyroidectomy: a prospective randomized trial. BMC Anesthesiol. 2021;21(1):103. \u003c/li\u003e\n\u003cli\u003eCho EA, Lee NH, Ahn JH, Choi WJ, Byun JH, Song T. Preoperative Oral Carbohydrate Loading in Laparoscopic Gynecologic Surgery: A Randomized Controlled Trial. J Minim Invasive Gynecol. 2021;28(5):1086-94.e1. \u003c/li\u003e\n\u003cli\u003eMousavie SH, Negahi A, Hosseinpour P, Mohseni M, Movassaghi S. The Effect of Preoperative Oral Versus Parenteral Dextrose Supplementation on Pain, Nausea, and Quality of Recovery After Laparoscopic Cholecystectomy. J Perianesth Nurs. 2021;36(2):153-6. \u003c/li\u003e\n\u003cli\u003eDoo AR, Hwang H, Ki MJ, Lee JR, Kim DC. Effects of preoperative oral carbohydrate administration on patient well-being and satisfaction in thyroid surgery. Korean J Anesthesiol. 2018;71(5):394-400. \u003c/li\u003e\n\u003cli\u003eZhang Z, Wang RK, Duan B, Cheng ZG, Wang E, Guo QL, Luo H. Effects of a Preoperative Carbohydrate-Rich Drink Before Ambulatory Surgery: A Randomized Controlled, Double-Blinded Study. Med Sci Monit. 2020;26:e922837. \u003c/li\u003e\n\u003cli\u003eRizvanović N, Nesek Adam V, Čau\u0026scaron;ević S, Dervi\u0026scaron;ević S, Delibegović S. A randomised controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing colorectal surgery. Int J Colorectal Dis. 2019;34(9):1551-61. \u003c/li\u003e\n\u003cli\u003eWu HY, Yang XD, Yang GY, Cai ZG, Shan XF, Yang Y. Preoperative oral carbohydrates in elderly patients undergoing free flap surgery for oral cancer: randomized controlled trial. Int J Oral Maxillofac Surg. 2022;51(8):1010-5. \u003c/li\u003e\n\u003cli\u003eNygren J. The metabolic effects of fasting and surgery. Best Pract Res Clin Anaesthesiol. 2006;20(3):429-38. \u003c/li\u003e\n\u003cli\u003eZuo X, Wang L, He L, Li P, Zhou D, Yang Y. Enhanced Recovery after Surgery Protocol Accelerates Recovery of Lumbar Disc Herniation among Elderly Patients Undergoing Discectomy via Promoting Gastrointestinal Function. Pain Res Manag. 2021;2021:3573460. \u003c/li\u003e\n\u003cli\u003eCho EA, Huh J, Lee SH, Ryu KH, Shim JG, Cha YB, Kim MS, Song T. Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study. Anesth Analg. 2021;133(3):690-7. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"perioperative-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"peri","sideBox":"Learn more about [Perioperative Medicine](http://perioperativemedicinejournal.biomedcentral.com)","snPcode":"13741","submissionUrl":"https://submission.nature.com/new-submission/13741/3","title":"Perioperative Medicine","twitterHandle":"@EMSurgeryBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"preoperative oral carbohydrate, quality of recovery-15, daytime oral surgery","lastPublishedDoi":"10.21203/rs.3.rs-4954722/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4954722/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePreoperative oral carbohydrate intake can improve the postoperative recovery of fasting patients in many kinds of surgeries; however, the effect of carbohydrates on patients undergoing daytime oral surgery is still unclear. This study was designed to evaluate the effect of preoperative oral carbohydrate intake on the quality of recovery of patients undergoing daytime oral surgery using the quality of recovery-15 (QoR-15) questionnaire.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eNinety-two patients scheduled for daytime oral surgery were randomly allocated to the midnight fasting group (F group, n\u0026thinsp;=\u0026thinsp;45) or the carbohydrate-Outfast loading group (O group, n\u0026thinsp;=\u0026thinsp;47). Participants in the F group fasted from midnight the day before surgery. Patients in the O group also fasted but received the Outfast drink (4 ml/kg) 2\u0026ndash;3 hours before the induction of anesthesia. QoR-15 questionnaire, patient well-being and satisfaction were assessed before anesthesia induction and 24 hours after surgery. Perioperative blood glucose, postoperative exhaust time and adverse events were also recorded.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe QoR-15 scores were significantly higher in the O group than in the F group preoperatively and postoperatively. Seven parameters representing patient well-being evaluated on numeric rating scale (NRS, 0\u0026ndash;10) were lower in the O group than in the F group postoperatively, except for the hunger and sleep quality scores. Patient satisfaction scores on a 5-point scale were higher in the O group than in the F group preoperatively and postoperatively. Meanwhile, the postoperative exhaust time was significant shorter in the O group compared to the F group, while there were no significant differences in blood glucose concentrations between these two groups.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePreoperative oral carbohydrate intake could improve postoperative recovery quality, well-being and satisfaction of patients undergoing daytime oral surgery 24 hours after surgery, and may serve as a treatment option for patients undergoing daytime oral surgery.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eThis trial was registered in the Chinese Clinical Trial Registry (ChiCTR2100053753) on 28/11/2021.\u003c/p\u003e","manuscriptTitle":"Effect of preoperative oral carbohydrate on the postoperative recovery quality of patients undergoing daytime oral surgery: a randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-16 08:21:06","doi":"10.21203/rs.3.rs-4954722/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-13T14:27:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-04T18:38:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110672280375183602807884191537227460070","date":"2024-09-04T16:43:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-04T15:09:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-23T06:25:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-23T06:23:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Perioperative Medicine","date":"2024-08-22T03:13:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"perioperative-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"peri","sideBox":"Learn more about [Perioperative Medicine](http://perioperativemedicinejournal.biomedcentral.com)","snPcode":"13741","submissionUrl":"https://submission.nature.com/new-submission/13741/3","title":"Perioperative Medicine","twitterHandle":"@EMSurgeryBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f620db29-111d-4eeb-866f-27b50ac007cf","owner":[],"postedDate":"October 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-21T16:00:26+00:00","versionOfRecord":{"articleIdentity":"rs-4954722","link":"https://doi.org/10.1186/s13741-024-00459-8","journal":{"identity":"perioperative-medicine","isVorOnly":false,"title":"Perioperative Medicine"},"publishedOn":"2024-10-14 15:57:14","publishedOnDateReadable":"October 14th, 2024"},"versionCreatedAt":"2024-10-16 08:21:06","video":"","vorDoi":"10.1186/s13741-024-00459-8","vorDoiUrl":"https://doi.org/10.1186/s13741-024-00459-8","workflowStages":[]},"version":"v1","identity":"rs-4954722","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4954722","identity":"rs-4954722","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}