///2015 Abstract Details
2015 Abstract Details2019-08-02T16:54:43-06:00

Preoperative Carbohydrate Loading for Elective Cesaraen Delivery

Abstract Number: F-05
Abstract Type: Original Research

Andrew Clark MBCHB, FRCA1 ; Ravi Agaram MBCHB, FRCA2; Kerry Litchfield MBCHB, FRCA3; Alvin Soosay MBCHB4

Fasting prior to 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


Methods: 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 disease). 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 for at the commencement 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.

Results: Twenty-two (30 percent) of 76 mothers were ketotic

compared to 51 percent in the control group (p = 0.016). The

average time from solid food was 15 hours (range 10 - 21) in

the control and 15.8 (range 9 - 23) in the carbohydrate group.

The spread of ketonuria over the operative period is displayed

in figure 1.

Discussion: Ensuring the mother is in the best possible condition

prior to 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 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:


2. Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ,

Horgan AF. Preoperative oral carbohydrate loading in colorectal

surgery: a randomized controlled trial. Colorectal Disease 2006; 8:


3. Lucas DN, Gough KL. Enhanced recovery in obstetrics–a new

frontier?. Int J Obstet Anesth 2013; 22.2: 92-95.

SOAP 2015