Preoperative Carbohydrate Loading for Colorectal Surgery

Carbohydrate Type and Administration Recommendations

The American Society for Enhanced Recovery recommends preoperative carbohydrate drinks containing complex carbohydrates, specifically maltodextrins at a concentration of approximately 12.5%, to achieve optimal metabolic benefits 1, 2
The standard recommended dose is 400ml of a 12.5% complex carbohydrate solution administered 2-3 hours before anesthesia induction, with an additional 800ml dose the evening before surgery 1, 2, 3, 4

Complex carbohydrate loading helps patients undergo surgery in a metabolically fed state, reducing postoperative insulin resistance by more than 50% 2
Preoperative complex carbohydrate administration results in reduced preoperative thirst, hunger, and anxiety, decreased postoperative protein breakdown, and better-maintained lean body mass and muscle strength 1, 2, 3
Complex carbohydrate loading is associated with lower insulin requirements, less hyperglycemia, and potentially shorter hospital stays 1, 2

The ERAS Society strongly recommends preoperative carbohydrate drinks as part of the standard protocol for elective colorectal surgery, including patients with uncomplicated type-2 diabetes and obese patients 2, 3
Patients with delayed gastric emptying require special consideration, and emergency surgery patients should remain fasted according to standard protocols 1, 2
While carbohydrate drinks can be given to patients with well-controlled diabetes, the evidence for this practice is still limited 1, 2