A 60-year-old patient undergoes major elective colorectal surgery. As part of the ERAS (Enhanced Recovery After Surgery) protocol, when should preoperative carbohydrate loading be given?

• A 24 hours before surgery
• B 2 hours before surgery (clear carbohydrate drink) ✓
• C 6 hours before surgery
• D The night before surgery only

Explanation

ERAS Society guidelines recommend a clear carbohydrate drink (typically 12.5% maltodextrin, 400 mL) up to 2 hours before general anesthesia induction. This reduces insulin resistance, attenuates the catabolic surgical stress response, preserves lean muscle mass, and is safe as clear fluids are cleared from the stomach within 2 hours. Patients are allowed clear fluids until 2 hours and solids until 6 hours preoperatively. Traditional prolonged overnight fasting is no longer justified and increases insulin resistance and patient discomfort.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.