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Effectiveness and safety of preoperative carbohydrate loading in pediatric patients: A systematic review and

Zhenlong Yan1, Yanan Xu2, Rongxiong Dai1

  • 1Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.

Journal of Pediatric Surgery
|March 26, 2026
PubMed

Insights

Preoperative carbohydrate loading (PCL) in pediatric patients improves anesthesia cooperation and reduces postoperative nausea and vomiting (PONV). Compound carbohydrate solutions offer a favorable metabolic safety profile, stabilizing insulin levels and reducing insulin resistance.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Metabolic Medicine

Background:

  • Preoperative fasting is standard for pediatric surgery, but can lead to metabolic stress and discomfort.
  • Preoperative carbohydrate loading (PCL) is an emerging strategy to mitigate fasting-related issues.
  • Evaluating PCL's impact on pediatric surgical outcomes is crucial for optimizing patient care.

Purpose of the Study:

  • To systematically evaluate the efficacy and safety of PCL in pediatric patients undergoing surgery.
  • To assess PCL's effects on behavioral indices, metabolic parameters, and postoperative nausea and vomiting (PONV).
  • To compare the metabolic profiles of standard versus compound carbohydrate solutions in PCL.

Main Methods:

  • A meta-analysis adhering to PRISMA 2020 guidelines was conducted.
  • Searched nine databases for randomized controlled trials (RCTs) of PCL in patients ≤18 years.
  • Analyzed outcomes including anxiety, sedation, mask acceptance, blood glucose, insulin, insulin resistance, and PONV.

Main Results:

  • PCL significantly improved cooperation during anesthesia induction, reducing anxiety and enhancing sedation.
  • PCL stabilized metabolic status, with compound solutions reducing postoperative insulin and insulin resistance.
  • PCL markedly reduced PONV incidence, particularly moderate-to-severe episodes.

Conclusions:

  • Preoperative carbohydrate loading offers multifaceted benefits in pediatric surgery.
  • Compound carbohydrate solutions present a favorable metabolic safety profile compared to standard solutions.
  • Tailoring PCL based on solution type is recommended for clinical application.
Abstract

Keywords:
Insulin resistanceMeta-analysisPediatricPostoperative nausea and vomitingPreoperative carbohydrate loading

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