The Shift from Traditional Fasting
For many years, patients were told to fast from both food and drink from midnight the night before surgery. This was done to prevent pulmonary aspiration—stomach contents entering the lungs during anesthesia. The risk is real, but also rare. The fasting protocol had negative effects on the body. Prolonged fasting causes a catabolic state, where tissue breaks down.
The metabolic stress response to surgery is well-documented. In a fasted state, this response is intensified, leading to:
- Increased Insulin Resistance (IR): Cells become less responsive to insulin, which raises blood sugar levels. This hyperglycemia increases the risk of complications and longer hospital stays.
- Protein and Muscle Loss: The body breaks down protein stores, including muscle mass, for energy without adequate carbohydrates. This hinders postoperative recovery.
- Patient Discomfort: Prolonged fasting increases hunger, thirst, and anxiety, impacting overall well-being.
Benefits of Preoperative Carbohydrate Loading
Replacing overnight fasting with a carbohydrate-rich drink before surgery shifts the body's metabolic state. Known as carbohydrate loading, this provides benefits:
- Attenuates Insulin Resistance: Drinks provide glucose, which minimizes insulin resistance after surgery.
- Reduces Protein Breakdown: The body uses carbohydrates for energy, reducing the need to break down muscle tissue.
- Improves Patient Comfort: Patients who get carbohydrate drinks report less hunger, thirst, and anxiety.
- Potentially Reduces Hospital Stay: Promoting faster metabolic recovery and preserving muscle function can shorten hospital stays.
- Does Not Increase Aspiration Risk: The drinks, typically with maltodextrin, are formulated to be clear and rapidly absorbed, ensuring the stomach is empty.
Why is the Change Recommended?
| Feature | Traditional Overnight Fasting | Preoperative Carbohydrate Drinks (ERAS) |
|---|---|---|
| Metabolic State | Leads to a catabolic state, increasing surgical stress. | Promotes an anabolic state, preparing the body for stress. |
| Energy Source | Body burns protein (muscle) and fat for fuel due to lack of glucose. | Provides external glucose, preserving energy stores. |
| Insulin Response | Worsens postoperative insulin resistance, increasing complication risks. | Attenuates the insulin resistance caused by surgical stress. |
| Patient Comfort | Often results in hunger, thirst, and anxiety for hours before surgery. | Significantly reduces feelings of hunger, thirst, and preoperative anxiety. |
| Recovery | Can lead to longer hospital stays due to metabolic disruption and muscle wasting. | Associated with a shorter hospital stay and better overall recovery. |
The Role of ERAS
Carbohydrate drinks are a key part of ERAS programs. These protocols integrate strategies to enhance recovery and minimize complications. This patient-centered strategy has transformed surgical care. By focusing on metabolic preparation, ERAS helps the body withstand surgery and speed up healing. This approach marks a significant evolution in surgical care.
Conclusion
Drinking carbohydrate drinks before surgery is an evidence-based practice to optimize recovery and comfort. By providing carbohydrates, medical teams counteract the effects of fasting, controlling blood sugar levels and preserving muscle mass. This modern approach reduces hunger and thirst, leading to a better patient experience. This is a testament to advancements in perioperative medicine, prioritizing patient well-being for a faster return to health.
