Impact of maltodestrin intake in elective caesarean section: A randomised study

BACKGROUND: Despite strong scientific evidence supporting the efficacy of Enhanced Recovery After Surgery protocols for managing surgical patients, the practice of overnight fasting remains one of the most widely accepted medical rules globally, causing discomfort to patients. In patients undergoing cesarean section, the administration of maltodextrins seems to reduce postoperative insulin resistance, improving blood glucose levels (BGL). Perioperative oral carbohydrate loading seems to attenuate hypotension associated with vasodilatation during spinal anesthesia. The aim of this randomized trial was to compare the perioperative administration of maltodextrins with clear water, evaluating both perioperative and postoperative BGL and comparing hemodynamic stability by the adoption of ClearSight® system. METHODS: The study included 34 patients undergoing elective caesarean section, randomly assigned in a 1:1 ratio to one of two groups: patients treated with 200 ml maltodextrin (PreOp® by Nutricia) (Group M), and patients treated with 200 ml clear water 2 h before the surgery (Group C). In each group preoperative and postoperative blood glucose level, APGAR at 1 and 5 min, newborn blood gas analysis, total duration of monitoring and total duration of hypotensive events, Mean Arterial Pressure, Cardiac Index, Stroke Volume Variation and Stroke Volume index were recorded. Also, Time Weighted Average was calculated. RESULTS: Preoperative and postoperative BGL differed in C group, while preoperative BGL showed no difference between the two groups. Postoperative BGL was significantly different between M and C group. Evaluating hemodynamic parameters, a significant difference was observed between preoperative and intraoperative MAP both in group C and group M, as well as between preoperative and postoperative MAP in group C (p = 0.007). CI differed significantly between intraoperative and postoperative values only in group C (p = 0.02). Finally, SVV in group C differed between intraoperative and postoperative values (p = 0.02). No differences were found in newborn parameters. CONCLUSIONS: In conclusion, our randomized control study shows how preoperative carbohydrate loading is safe and could improve the surgical stress response, without having an impact over the neonates and hemodynamic of the mother. TRIAL REGISTRATION: ClinicalTrial. gov ID: NCT05553756; date of registration 2022-09-21.