Preoperative Carbohydrate Loading

What is Preoperative Carbohydrate Loading?

In recent years, numerous healthcare professionals around the world have decided it was time to revisit the practice of preoperative fasting prior to elective surgery. This practice was originally enforced to avoid having patients regurgitate and aspirate gastric contents.

But with notable disadvantages in preoperative fasting – such as dehydration and insulin resistance – healthcare professionals are innovating ways to improve perioperative and post-operative conditions, including one such method referred to as preoperative carbohydrate loading, or ‘ preop carb loading’.

What are the Benefits of Preoperative Carb Loading?

As part of the ‘Enhanced Recovery After Surgery’ pathways, preoperative carb loading helps safeguard patients by minimizing the stress response to surgery. Preop card loading is administered orally, in drink form, and is designed to be safely consumed a few hours before surgery as well as a few days before the surgery, depending on the patient.

Oral preoperative carbohydrate loading has many benefits for patients, the most commonly cited benefits being comfort and well-being as well as a reduction of weakness and tiredness. Other benefits include:

  • Reduction in postoperative insulin resistance
  • Improvement in preoperative patient well-being (thirst, hunger, dehydration, headache, nausea, and vomiting)
  • Reduction in protein loss
  • Improved postoperative muscle function
  • Reduced length of hospital stay 

Where Can I Learn More about Preoperative Carb Loading?

We've compiled a list of studies that explore the global effort to optimize patient recovery from surgery:

Maltby, JR, Sutherland, AD, Sale, JP, and Shaffer, EA. Preoperative oral fluids: is a five-hour fast justified prior to elective surgery?. Anesth Analg1986651112–1116

Frisch, A, Chandra, P, Smiley, D et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care2010331783–1788

Kwon, S, Thompson, R, Dellinger, P, Yanez, D, Farrohki, E, and Flum, D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg20132578

Sato, H, Carvalho, G, Sato, T, Lattermann, R, Matsukawa, T, and Schricker, T. The association of preoperative glycemic control, intraoperative insulin sensitivity and outcomes after cardiac surgery. J Clin Endocrinol Metab2010954338–4344

Ljungqvist, O, Thorell, A, Gutniak, M, Häggmark, T, and Efendic, S. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance. J Am Coll Surg1994178329–336

Thorell, A, Alston-Smith, J, and Ljungqvist, O. The effect of preoperative carbohydrate loading on hormonal changes, hepatic glycogen, and glucoregulatory enzymes during abdominal surgery.Nutrition199612690–695

Nygren, J, Thorell, A, Jacobsson, H et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg1995222728–734

Scott, MJ and Fawcett, WJ. Oral carbohydrate preload drink for major surgery—the first steps from famine to feast. Anaesthesia201469308–313