Objective: to study the efficacy and safety of the method of preoperative preparation with the use of osmotic laxative (macrogol) in
adult cardiosurgical patients.
Material and methods. Eighty patients aged 56 (47–61) years who admitted for surgical treatment of acquired heart disease were
consecutively included in a prospective randomized study. Randomization was carried out using the envelopes method. Before surgery
26/40 (65%) patients in the study group and 22/40 (55%) in the control group had the III and IV NYHA class (p=0.18).
EuroSCORE score in the study group was 2.7 (2.1–5.5) points and 3.3 (2–5.5) points in the control group (p=0.2). Preoperative
preparation of patients in the study group included the removal of intestinal contents by oral administration of an aqueous macrogol
solution. The last meal was allowed at 11 a.m. the day before surgery, after 1.5–2 hours after that patients started to take orally
macrogol solution (64 g of macrogol dissolved in 1 liter of water per 20 kg of body weight). The whole volume of the solution had
taken fractionally in 3–6 hours. In the control group routine preparing for surgery with a cleansing enemas was provided. Both groups
underwent standard perioperative antibiotic prophylaxis with cefuroxime. Demographic and main clinical data were recorded; systemic
inflammation syndrome (SIRS) indices of and procalcitonin (PCT) concentration at 1, 3 and 6 days after surgery were defined.
The data are presented as absolute values, fractions, as well as the median and interquartile range (25th–75th percentiles).
Mann–Whitney U-test was used to compare the data, p-values less than 0.05 were accepted as statistically significant.
Results. There were no significant changes in the major vital signs (heart rate, respiratory rate, blood pressure) as well as fluid and
electrolyte dysbalance after macrogol solution taking. Clinical features of SIRS in 1, 3 and 6 days after surgery were registered in 27.5,
35 and 15% patients in the study group and 32.5, 50 and 22.5% cases in control group respectively (p>0.05). Statistically significant
differences in PCT levels between the groups were absent during the entire observation period. Postoperative mechanical lung ventilation
lasted 19 (12–24) hours in the study group and 20 (14–24) hours in control group (p=0,43). The duration of hospital stay was
16 (14–20) days in the study group and 15 (13–18) days in the control group (p=0.21). There were 1 death (2.5%) in the control
group due to multiorgan failure; in the study group all patients were alive. Oral macrogol treatment was well-tolerated and high compliance
of patients and staff was noted.
Conclusion. Preoperative preparation with the use of macrogol is an effective and safe method of cleansing the gut before cardiac
operations for adult patients. The feasibility of routine use of this approach needs further study.
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