Debate 2A - Should Preoperative Carbohydrate Loading be Routine prior to Debulking Surgery?

Summary

The endocrine and immunologic systems demonstrate pronounced derangements in response to surgical stress. Such responses are exacerbated by a fasting state and correlate with surgical complexity. Proven reductions in insulin resistance provide the physiologic rationale for the use of oral carbohydrate loading prior to surgery. While evidence of clinical benefit is of low to moderate quality, preoperative carbohydrate loading is neither costly nor labor intensive, improves patient satisfaction and well-being, and should be incorporated into Enhanced Recovery After Surgery protocols given the very low risk of harm. Recognizing the high surgical complexity of cytoreductive surgery in patients with ovarian cancer and the high incidence of mild to moderate nutritional compromise, these patients may have comparatively more to gain from carbohydrate loading. ERAS® Society guidelines for gynecologic surgery provide a strong recommendation grade for preoperative carbohydrates up until two hours prior to induction of anesthesia.