Impact of Oral Carbohydrate Consumption Prior to Cesarean Section
Condition: Dehydration
MeSH terms: Dehydration
Study type: Interventional

Summary: 
      For more than 15 years, traditional fasting regimens prior to scheduled surgeries have been
      called into question, yet prolonged preoperative fasting remains common practice. While
      prolonged fasting is aimed at reducing the risk of pulmonary aspiration, prolonged fasting is
      uncomfortable, has an inconsistent effect on gastric volumes and acidity and may lead to
      dehydration without a clear reduction in the incidence of aspiration. Fasting by itself
      decreases hepatic glycogen stores, induces a state of insulin resistance and impairs
      cardiovascular function. Yet, prolonged preoperative fasting remains common.

      Preoperative oral carbohydrate (CHO) consumption improves insulin sensitivity and decreases
      the time to return of gut function without increasing gastric volumes or acidity compared to
      other clear liquids and fasting. Previous work has shown oral CHO consumption improves
      patient well-being to a greater degree than placebo drink (water or flavored water) and
      fasted controls. Oral CHO also outperforms a similar volume of intravenous glucose
      supplementation. These benefits have reduced hospital stays in a variety of surgical models
      by as much as 20%. Further, preoperative CHO supplementation improved postoperative patient
      hunger, thirst, anxiety, fatigue and nausea.

      The purpose of this research study is to determine if drinking a high carbohydrate beverage
      before cesarean section surgery can improve patient well-being, compared to patients who
      drink a low carbohydrate beverage or fast before surgery.
    

Detailed description: 
      The study hopes to determine if either of two different oral beverages (a higher CHO
      concentration versus a lower CHO concentration) is superior to routine fasting in terms of
      preoperative well-being among patients presenting for scheduled cesarean section.
      Preoperative well-being will be determined by a composite of visual analog scale scores aimed
      at assessing hunger, thirst, anxiety, fatigue and nausea on the morning of surgery.

      Women will be recruited from one of two outpatient obstetric clinics, University of Florida
      (UF) Health Women's Center - Medical Plaza or UF Health Women's Center. Women presenting for
      scheduled cesarean section will be provided with an opportunity to participate. Then the
      women will be randomized into one of three groups: oral carbohydrate beverage (group CHO),
      re-hydration beverage of an equal volume (group R) or fasted controls (group F). All subjects
      who consent to participation will have the following recorded: height, weight, age,
      indication for cesarean section, surgeon, and number of prior cesarean sections.
    

Intervention name(s): Oral Carbohydrate Beverage; Rehydration beverage
Intervention type(s): Dietary Supplement; Dietary Supplement
Intervention description(s): The oral carbohydrate beverage will be consume in a 710 mL amount the evening prior to surgery and then a 355 mL amount the morning of surgery.; The rehydration beverage group will be consume in a 710 mL amount the evening prior to surgery and then a 355 mL amount the morning of surgery.
Other intervention name(s): Preoperative beverage; Preoperative beverage
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Health Services Research
Keywords: Well-being; Quality of Recovery; Maternal complications