Preoperative carbohydrates: what is new?

Area of Science:

• Surgical nutrition
• Metabolic response to surgery
• Perioperative care

Background:

• Preoperative fasting is a standard surgical practice.
• Carbohydrate loading is an emerging strategy to mitigate surgical stress.
• Evidence on the efficacy and safety of preoperative carbohydrate loading is evolving.

Purpose of the Study:

• To provide an overview of recent literature on preoperative carbohydrate loading in surgical patients.
• To synthesize current evidence regarding the effects of carbohydrate loading on perioperative outcomes.
• To identify gaps in the existing research and suggest future directions.

Main Methods:

• Systematic literature search from January 1, 2017, to December 31, 2019.
• Inclusion of 26 publications: 17 randomized clinical trials, 3 prospective observational studies, and 6 retrospective series.
• Analysis of studies focusing on the effects of carbohydrate load, dose, and timing.

Main Results:

• Most studies were underpowered with high variability in carbohydrate (CHO) dose and timing.
• Recent literature supports preoperative carbohydrate loading up to 2 hours before surgery as safe.
• Evidence confirms reduced perioperative insulin resistance and hyperglycemia, with improved patient well-being and comfort.
• No significant impact on surgery-related morbidity was observed.

Conclusions:

• Preoperative carbohydrate loading is a safe and beneficial strategy for surgical patients.
• The strategy effectively manages perioperative metabolic disturbances and enhances patient comfort.
• Further well-designed randomized clinical trials are needed to evaluate clinically relevant endpoints like hospitalization length and morbidity.