50 g of Pre-Operative Carbohydrate Loading?

February 4, 2020

ENSURE PRE-SURGERY is specially designed to help reduce insulin resistance after surgery and improve patient outcomes. Designed to be consumed up to 2 hours before surgery. For oral use. Use under medical supervision. • #1 Doctor recommended brand.
• Has a recommended dose of carbohydrates (50 g per serving), as indicated by ERAS guidelines*, compared to regular sports drinks, which contain approximately 21 g per 12-fl-oz serving.
• Meets ERAS guidelines* for pre-surgery use of a clear carbohydrate beverage.1,2
• Meets American Society of Anesthesiologists (ASA®) guidelines† for use with preoperative fasting.3

The official Enhanced Recovery After Surgery (ERAS) Society’s recommendations for most common surgeries:
Evidence Level Moderate (for not recommending)
Recommendation grade strong

This is where marketing trumped medical care.

In actuality “Insulin resistance is a central metabolic change during surgical stress that is directly proportional to the magnitude of the operation.” This leads me to two opposing viewpoints, that need to be rectified:

Preoperatively administering glucose may, in fact, cause reactive hypoglycemia intra-operatively in the exact population you would want to avoid glycemic excursions.

Inadvertent intracranial hypotension with acute neuronal damage may result in penumbra extension of injury in the presence of hyperglycemia.

Perhaps, idealizing metabolic function should be the ideal preoperative therapy.