The impact of oral carbohydrate-rich supplement taken two hours before caesarean delivery on maternal and neonatal perioperative outcomes -- a randomized clinical trial

Abstract

Background To evaluate the impact of oral carbohydrate-rich (Ch-R) supplement taken 2 hours before an elective caesarean delivery (CD) on maternal and neonatal perioperative outcomes. Methods Ninety pregnant women undergoing elective CD were randomized into the Ch-R group, placebo group and fasting group equally. Participants’ blood was drawn at three time points, before intervention, immediately after and 1 day after the surgery to measure maternal and neonatal biochemical indices. Meanwhile women’s perioperative symptoms and signs were recorded. Results Eighty-eight pregnant women were finally included in the study. Women who had drunk Ch-R supplement had lower postoperative insulin level (β = − 3.50, 95% CI − 5.45 to − 1.56), as well as postoperative HOMA-IR index (β = − 0.74, 95% CI − 1.15 to − 0.34), compared with women who had fasted. Additionally, neonates of mothers who were allocated in the Ch-R group also had a higher glucose level, compared with neonates of mothers in the fasting group (β = 0.40, CI 0.17 to 0.62). Conclusion Oral Ch-R solution administered 2 hours before an elective CD may not only alleviate maternal postoperative insulin resistance, but also comfort women’s preoperative thirst and hunger, compared to fasting. Additionally, it may increase neonatal glucose level as well. Trial registration Chinese Clinical Trial Registry, ChiCTR2000033163. Data of Registration: 2020-5-22.

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

“…Preoperative carbohydrate loading may improve insulin resistance and reduce PONV and hospital LOS [ 95 , 96 ]. In general, single-dose dexamethasone up to 10 mg raises blood glucose with similar preoperative to maximal intraoperative glucose concentration of 63 ± 69 mg/dL in diabetics and to 72 ± 45 mg/dL in nondiabetics [ 97 , 98 , 99 , 100 , 101 ]. Preoperative hyperglycemia is associated with increased SSI risk, among others, especially in the elderly [ 102 , 103 ].…”

Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials

“…Twenty-two studies were included, with data available for 1,379 participants ( 9 , 29 , 30 , 33 , 34 , 36 – 46 , 48 – 50 , 61 , 64 , 65 ). Compared with placebo or water, high-dose carbohydrate loading before surgery was associated with a decrease in Fin level (MD, –5.53 [95%Crl, –10.61 to –0.62]).…”

Framework, component, and implementation of enhanced recovery pathways

“…The addition of preoperative whey protein has also been associated with improved recovery [ 19 ]. Another major advantage conferred is a reduction in anxiety and mouth dryness [ 20 ], which improves patient comfort. However, preoperative carbohydrate loading remains controversial due to the quality of some underlying studies and a lack of evidence demonstrating a clear reduction in clinical complications [ 21 ].…”