Carb Loading for Surgery: Dr. Paul Wischmeyer

so I think another key opportunity we have to improve the outcome of patients having operations having surgeries is the role of car load the car loing before the operation and so we have robust evidence that if you give about 50 grams of moltex a complex carbohydrate two hours before the operation as a clear liquid you can reduce complications and length of stay significantly in fact you can reduce the length of stay of a patient having a major abdominal operation by one and a half days again these are little drinks or little little little drinks that cost a few dollars that could save days in the hospital and thousands of dollars in costs to the hospital and to the patient and so just on that alone this is enormous effect but it has to be done correctly so all the studies that have been done to this Point have used a certain amount of a complex carbohydrate called MTO Dean existing in the right concentration and the right osmolarity um to be safe for someone to take two hours before surgery our anesthesia guidelines on an anesthesiologist by training say that you can take clear liquids up to two hours before surgery safely and so we often hear people concerned about the car saying we don't want our patients drinking something two hours before surgery but our guidelines that have existed since before I was a resident so more than 20 years now say it is entirely safe and reasonable to take a clear liquid up to two hours before an operation without worrying about aspiration when you send people off to sleep and induce them and have to put a breathing tube in and so I think that's the first hurdle that we've had is I think anesthesiologists and surgeons have said oh I don't know about giving patients things to drink like that two hours before surgery what our guidelines have always said that was safe so that is not an issue and that should never be thought of as an issue but I think what is critical is this has to be done correctly and unfortunately what's happened with this new literature showing these exciting benefits that that go beyond actually just the length of stay people who take these carb loads also have less nause and vomiting after surgery less thirst less pain they feel better they eat sooner they go home sooner there's lots of benefits to this but what's happened unfortunately is people have said well why don't we just give them any kind of carb hydrate sugar containing drink before surgery why don't we give them Gatorade or a sports drink or orange juice and wouldn't that be the same well it's not the same a they haven't been studied and so we don't know if they benefit the patient because the key of the maltodextrin is it was formulated that way because it induces reductions in insulin resistance when given that precise way and we don't have any evidence that the other carbohydrate loading Solutions have that same benefit or have any benefit the other problems with the simple sugars of Gatorade and orange juice and other sports drinks is is they don't empty the stomach the same way and they could increase the risk of aspiration right all the research has been done with a complex carbohydrate malod dextran and all the research it shows it's safe to do the patients don't aspirate and they have better outcomes have been done with only that specific carbohydrate mixture if your patient or a patient was to aspirate and have a complication because they had Gatorade or or juice you couldn't really defend yourself because there's no evidence to say it's safe we know that simple sugars and the osmolarity of those drinks is not the same and don't into the stomach perhaps as successfully or as efficiently and and why would you use something that there's no evidence for and could create risk I think the other key feature that needs to go into doing these correctly is these drinks need to be taken over about five to 10 minutes they need to be taken in quickly and so we have to instruct our patients to do that they can't be sipped over hours and then I think the other thing that has kind of begun to permeate into some of the commercially available carbo drinks is people have thought it was a good idea to add amino acids like arine or citruline or some of the other amino acids that may benefit surgical patients in other settings the problem is we know amino acids especially things like Arginine and citrine that generate nitric oxide can delay gastric emptying and so they can slow the stomach empting they could potentially lead to increased risk of aspiration and complications for the patient so again none of us that have studied this literature for a long time or does research in this area which suggests using drinks that also contain amino acids as a attractive an idea that may have been and so I think what's important and unique about carb ready is it uses the carbohydrate content and concentration that exactly mimics the one that has been studied for years to be beneficial and safe and I think that's what's critical anyone who's trained for a marathon knows that you don't go into a marathon or a major dress which a marathon is without carbohydrate loading the night before and the morning of and that's how we suggest our patients do it they should take two amounts of the carb load or 100 grams of of the of the sugar the complex carbohydrate the night before surgery before midnight and then one car load um carb ready drink the morning of surgery just like someone running a race or a marathon would do again the body doesn't do well it doesn't tolerate stress well when it's fasted immediately before the stress and that's what our fasting guidelines often make our patients do but now we've overcome that through the safe use of these chol liquid carbohydrate loading drinks but it's critical that the right concentration and right content which is what carb ready delivers is what's used because that's the only thing we have evidence for safety and benefit from and I think that's essential and that's why this product is so important it provides patients with exactly what has been studied and what they need in a simple to use formulation