India: Recent research highlights the potential benefits of preoperative carbohydrate loading in preventing perioperative ketoacidosis during elective cesarean deliveries. The study suggests that administering an oral carbohydrate drink two hours before surgery can enhance clinical outcomes, providing a safer approach for patients.
"An oral carbohydrate (CHO) drink is safe to administer two hours before uncomplicated elective cesarean deliveries and may positively impact various perioperative clinical outcome markers," the researchers wrote in the Journal of Anaesthesiology Clinical Pharmacology.

Long periods of fasting during the third trimester of pregnancy can be harmful, as they may cause hypoglycemia, elevated free fatty acid (FFA) levels, and increased ketones in the blood and urine. In these cases, preoperative carbohydrate-rich drinks may help. The Enhanced Recovery After Surgery (ERAS) guidelines suggest offering oral CHO fluid supplementation to nondiabetic pregnant women two hours before a cesarean delivery.
Against the above background, Ankita Sharma, Dayanand Medical College, Ludhiana, Punjab, All India Institute of Medical Sciences Bathinda, Punjab, India, and colleagues aimed to evaluate the effectiveness of preoperative oral CHO loading in preventing perioperative ketoacidosis during elective cesarean deliveries.
For this purpose, the researchers enrolled 120 parturients classified as American Society of Anesthesiologists (ASA) II/III who were undergoing elective cesarean sections with subarachnoid block (SAB). After providing written informed consent, the participants were divided into two groups of 60. Group A received 400 ml of filtered water two hours before surgery, while Group B received 400 ml of a nonparticulate CHO drink.

The primary outcome measured was the incidence of ketonuria, assessed using the dipstick method. Secondary outcomes included hunger and thirst scores, anxiety levels, dominant hand grip strength, and the quality of recovery scores.
The following were the key findings of the study:
Urine ketone levels were positive (+1) in 8.3% of participants in Group A, compared to only 1.7% in the carbohydrate (CHO) group.
The CHO group also reported significantly lower hunger and thirst scores and modified Beck’s anxiety scores.
Dominant hand grip strength remained stable in both groups.
The quality of recovery score was significantly higher in the CHO group.
No serious adverse effects were observed in either group.
The researchers wrote, "From our results, we conclude that allowing clear fluids or a nonparticulate carbohydrate drink up to two hours before surgery is safe for the parturient. This practice may help improve preoperative discomfort related to hunger, thirst, and anxiety."
They further noted, "the quality of recovery regarding postoperative experiences such as pain, nausea, vomiting, and overall comfort improved with CHO loading. Thus, administering oral CHO drinks before surgery is safe for elective cesarean deliveries and may positively influence perioperative clinical outcomes."
Reference:
Sharma A, Singh U, Kaur G, Grewal A, Maingi S, Tidyal S. Role of preoperative carbohydrate loading for prevention of perioperative ketoacidosis in elective cesarean delivery. JAnaesthesiol Clin Pharmacol 2024;40:439-44.