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Randomized Controlled Trial
. 2023 Apr 25;18(4):e0283780.
doi: 10.1371/journal.pone.0283780. eCollection 2023.

The effect of adding chewing gum to oral carbohydrates on preoperative anxiety scores in women undergoing gynecological surgery: A randomized controlled study

Yu Jeong Bang  1 , Jong-Hwan Lee  1 , Chung Su Kim  1 , Dan-Cheong Choi  1 , Joseph J Noh  2 , Yoo-Young Lee  2 , Jeong-Jin Min  1
Affiliations
Randomized Controlled Trial

The effect of adding chewing gum to oral carbohydrates on preoperative anxiety scores in women undergoing gynecological surgery: A randomized controlled study

Yu Jeong Bang et al. PLoS One. .

Abstract

Background: Preoperative anxiety is an unpleasant experience that can adversely affect perioperative outcomes. Although clinical benefits of preoperative oral carbohydrate is well reported, the effect of adding chewing gum to carbohydrate loading has never been studied. We aimed to investigate the effect of adding gum-chewing to oral carbohydrates on preoperative anxiety and gastric volume in patients undergoing gynecologic surgery.

Methods: One hundred and four patients were enrolled and randomized either into a carbohydrate drink group (CHD group) or CHD with gum group. The CHD group was instructed to drink 400 mL of oral carbohydrate the evening before and 200-400 mL 3 hours before surgery. The CHD with gum group was encouraged to chew gum freely during preanesthetic fasting in addition to consuming oral carbohydrates in the same manner. The primary endpoint was preoperative anxiety assessed using the Amsterdam preoperative anxiety and information scale (APAIS). The degree of patient-reported quality of recovery after surgery and gastric volume prior to general anesthesia were also compared as secondary outcomes.

Results: Preoperative APAIS was lower in the CHD with gum group compared with the CHD group (16 [11.5, 20] vs. 20 [16.5, 23], p = 0.008). Patient-rated quality of recovery after surgery was also higher in the CHD with gum group and showed a significant negative correlation with preoperative APAIS score (correlation coefficient: -0.950, p = 0.001). Gastric volume were not different between the groups (0 [0-0.45] vs. 0 [0-0.22], p = 0.158).

Conclusion: The addition of gum chewing to oral carbohydrate loading during preoperative fasting was more effective in relieving preoperative anxiety than oral carbohydrate alone in women patients undergoing elective gynecologic surgery.

Trial registration: Clinical Research Information Services, CRIS identifier: KCT0005714, https://cris.nih.go.kr/cris/index.jsp.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. CONSORT flow diagram of patients included in the study.
The control group comprised patients who followed preoperative fasting guidelines of the ASA and ERAS Society. The gum group comprised patients who were allowed to chew gum freely during the preoperative fasting period. ASA, American Society of Anesthesiologists; CONSORT, Consolidated Standards of Reporting Trials. ERAS, Enhanced Recovery After Surgery.
Fig 2
Fig 2. Comparison of preoperative anxiety score using the Amsterdam Preoperative Anxiety and Information Scale (APAIS).
Data were analyzed using Wilcoxon’s rank sum test.
Fig 3
Fig 3. Scatter plot showing the association between QoR-15K and APAIS scores measured in the preoperative holding area.
See this image and copyright information in PMC

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