title: Role of preoperative carbohydrate loading: a systematic review.
abstract: BACKGROUND
  Surgical stress in the presence of fasting worsens the catabolic state, causes insulin resistance and may delay recovery. Carbohydrate rich drinks given preoperatively may ameliorate these deleterious effects. A systematic review was undertaken to analyse the effect of preoperative carbohydrate loading on insulin resistance, gastric emptying, gastric acidity, patient wellbeing, immunity and nutrition following surgery.
  
  
  METHODS
  All studies identified through PubMed until September 2011 were included. References were cross-checked to ensure capture of cited pertinent articles.
  
  
  RESULTS
  Overall, 17 randomised controlled trials with a total of 1,445 patients who met the inclusion criteria were identified. Preoperative carbohydrate drinks significantly improved insulin resistance and indices of patient comfort following surgery, especially hunger, thirst, malaise, anxiety and nausea. No definite conclusions could be made regarding preservation of muscle mass. Following ingestion of carbohydrate drinks, no adverse events such as apparent or proven aspiration during or after surgery were reported.
  
  
  CONCLUSIONS
  Administration of oral carbohydrate drinks before surgery is probably safe and may have a positive influence on a wide range of perioperative markers of clinical outcome. Further studies are required to determine its cost effectiveness.
authors.affiliation: University Hospitals of Leicester NHS Trust, UK. dilrajbilku@yahoo.co.uk.
authors.forename: D K
authors.initials: DK
authors.lastname: Bilku
authors.forename: A R
authors.initials: AR
authors.lastname: Dennison
authors.forename: T C
authors.initials: TC
authors.lastname: Hall
authors.forename: M S
authors.initials: MS
authors.lastname: Metcalfe
authors.forename: G
authors.initials: G
authors.lastname: Garcea
mesh_terms: D000284:Administration, Oral; D001628:Beverages; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D005744:Gastric Acid / Q000502:physiology; D005746:Gastric Emptying / Q000502:physiology; D006304:Health Status; D006801:Humans; D007109:Immunity / Q000502:physiology; D007333:Insulin Resistance / Q000502:physiology; D009752:Nutritional Status; D061214:Patient Safety; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic
chemical_list: D004040:Dietary Carbohydrates