Oral Carbohydrate Loading for Elective Caesarean Delivery
A. Clark, A. Soosay, R. Agaram, K. Litchfield.
Princess Royal Maternity Unit, Glasgow, UK.
Fasting before elective caesarean delivery is associated with perioperative catabolism.1 For other major abdominal surgery, preoperative oral carbohydrate loading improves patient well-being.2 We aimed to pilot this for elective caesarean delivery.
Ethics approval was waived by the ethics chair. Over a six-week period, four carbohydrate drinks (Nutricia Pre-op, 50g carbohydrate) were distributed to mothers scheduled for caesarean delivery (excluding mothers with diabetes and severe gastroesophageal reflux). Instructions were given to drink two cartons at 10pm the night before and 7am on the morning of surgery. Presence of ketonuria, a marker of catabolism, was tested at the start of surgery using urinalysis (Ketostix, Bayer). An historical control group who fasted from midnight was used for comparison. Fisher's Exact Test (two tailed) was used for statistical analysis.
Twenty-two (30%) of 76 mothers were ketotic compared to 51% in the control group (P=0.016). The average time from solid food was 15 h (range 10-21) in the control and 15.8 h (range 9-23) in the carbohydrate group. The spread of ketonuria over the operative period is displayed in the figure.
Ensuring the mother is in the best possible condition before surgery is a cornerstone of obstetric enhanced recovery: a new frontier for the obstetric anaesthetist.3 We suggest that preoperative carbohydrate drinks deliver optimum preoperative nutrition: limiting the incidence of mothers undergoing surgery in the catabolic state. The Obstetric Anaesthetists' Association has awarded a grant to the authors to complete a randomised control trial to ascertain the effect of carbohydrate loading more clearly.
1. Clark A, Agaram R. Too fast? Ketonuria as a marker of prolonged fasting in elective caesarean section. Int J Obstet Anesth 2014; 23:S62.
2. Noblett SE, Watson DS, Huong H, et al. Preoperative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis 2006;8:563 –9.
3. Lucas DN, Gough KL. Enhanced recovery in obstetrics–a new frontier?. Int J Obstet Anesth 2013; 22: 92 -5.