Frequently Asked Questions (FAQ)

What is Preoperative Carbohydrate Loading?

Preoperative carbohydrate loading is a nutrition strategy where the patient consumes a complex carbohydrate drink (PREcovery®) before elective surgery, as an alternative to preoperative fasting.

In recent years, healthcare professionals around the world decided it was time to revisit the practice of preoperative fasting before elective surgery. This practice was originally enforced to avoid having patients regurgitate and aspirate gastric contents; however, with notable disadvantages of preoperative fasting (e.g., dehydration, insulin resistance), healthcare professionals are innovating ways to improve perioperative and post-operative conditions.13

What are the Benefits of Preoperative Carbohydrate Loading?

Preoperative carbohydrate loading has many benefits for patients and include:

  • Reduced postoperative insulin resistance1
  • Reduced length of hospital stay2,3
  • Reduced nitrogen & protein losses5,6
  • Reduced loss of lean body mass10
  • Improved patient well-being (e.g., decreased thirst, hunger, dehydration, headache, nausea, vomiting, anxiety, and fatigue)4,7-9
  • Improved postoperative muscle function.11,12

Is Aspiration a Concern with PREcovery®?

No. Fasting protocols were traditionally followed to ensure that patients had nothing left in their stomachs before the onset of anesthesia. However, research has shown that patients can consume clear fluids 2-3 hours before surgery without increasing the risk of aspiration.

Modern national anesthesia guidelines now recommend patients consume clear fluids 2-3 hours before surgery. PREcovery® is considered a clear fluid, and is a safe and effective alternative to traditional fasting protocols.14-16

How Does PREcovery® Compare with Juice or Sports Drinks?

Juice and sports drinks contain simple carbohydrates. Simple carbohydrates produce less than half the insulin response than do the complex carbohydrates found in PREcovery®.17,18

There is no evidence to support the safety or effectiveness of juice and sports drinks as a preoperative carbohydrate drink.

Can Individuals with Type 1 Diabetes Use PREcovery®?

No, individuals with type 1 diabetes cannot drink PREcovery®.

Individuals with type 1 diabetes have a chronic condition in which the pancreas produces little or no insulin (a hormone that helps sugars from foods/beverages enter into the cells for energy). As a result, drinking PREcovery® will not stimulate the desired insulin response in these individuals.19

Can Individuals with Type 2 Diabetes Use PREcovery®?

In general, yes, individuals with type 2 diabetes may drink PREcovery®.

Typically, the hospital or clinician will decide whether PREcovery® can be used in these patients. There is data supporting the safety of preoperative carbohydrate loading among people with type II diabetes, indicating that when compared to non-diabetic control:

  • The two groups have similar gastric emptying times
  • No difference between diet/oral medication controlled and insulin-controlled diabetes, and
  • No association between gastric emptying, glucose concentrations or HbA1c.20

What is the cost of PREcovery®?

PREcovery® is the most cost-affordable solution in North America. We work with distributors to determine the most cost-effective solution.

References

  1. Nygren J, et al. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nutr. 1998;17(2):65–71.
  2. ERAS Compliance Group. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg. 2015;261(6):1153-1159.
  3. Nygren J, et al. Preoperative oral carbohydrate nutrition: an update. Curr Opin Clin Nutr Metab Care. 2001;4(4):255–259.
  4. Hausel J, et al. Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. Br J Surg. 2005;92(4):415-21.
  5. Crowe PJ, et al. The effect of preoperative glucose loading on postoperative nitrogen metabolism. Br J Surg. 1984;71(8):635–637.
  6. Svanfeldt M, et al. Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics. Br J Surg. 2007;94(11):1342-1350.
  7. Brady M, et al. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst. Rev 2003;4:CD004423.
  8. Hausel J, et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth & Anal. 2001;93(5):1344-1350.
  9. Ljungqvist O, et al. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292-298.
  10. Yuill KA, et al. The administration of an oral carbohydrate-containing fluid prior to major elective upper gastrointestinal surgery preserves skeletal muscle mass postoperatively—a randomized clinical trial. Clin Nutr. 2005;24(1):32-37.
  11. Henriksen MG, et al. Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery. Acta Anaesthesiol Scand. 2003;47(2):191–199.
  12. Noblett SE, et al. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis 2006;8(7):563–569.
  13. J Fawcett W, Ljungqvist O. Starvation, carbohydrate loading, and outcome after major surgery. BJA Educ. 2017 May 15;17(9):312-6.
  14. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011 Mar;114(3):495.
  15. Dobson G, Chow L, Flexman A, Hurdle H, Kurrek M, Laflamme C, Perrault MA, Sparrow K, Stacey S, Swart P, Wong M. Guidelines to the Practice of Anesthesia–Revised Edition 2019. Can J Anaesth. 2019 Jan 15;66(1):75-108.
  16. Smith I, Kranke P, Murat I, Smith A, O'Sullivan G, Søreide E, Spies C, in't Veld B; European Society of Anaesthesiology. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011 Aug;28(8):556-69.
  17. Nygren J, Thorell A, Jacobsson H, Larsson S, Schnell PO, Hylen L et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg 1995; 222: 728–734.
  18. Karimian N, Moustafa M, Mata J, Al-Saffar AK, Hellström PM, Feldman LS, Carli F. The effects of added whey protein to a pre-operative carbohydrate drink on glucose and insulin response. Acta Anaesthesiol Scand. 2018 May;62(5):620-627.
  19. Mayo Foundation for Medical Education and Research. (2021, March 27). Type 1 diabetes. Mayo Clinic. Retrieved February 2, 2022, from https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011.
  20. Gustafsson UO, Nygren J, Thorell A, Soop M, Hellström PM, Ljungqvist O, Hagström-Toft E. Pre-operative carbohydrate loading may be used in type 2 diabetes patients. Acta Anaesthesiol Scand. 2008 Aug;52(7):946-51.