Effect of Preoperative Carbohydrate Loading on Serum Lactate Levels in Patients Undergoing Donor Hepatectomy

Overview

This randomized controlled trial investigated whether preoperative carbohydrate loading reduces perioperative serum lactate levels in patients undergoing donor hepatectomy. Participants were randomized into two groups: an intervention group receiving a standardized oral carbohydrate drink 2-4 hours before surgery, and a control group undergoing standard preoperative fasting. Serum lactate levels were measured at five perioperative time points: induction of anaesthesia, before graft removal, 30 minutes after graft removal, before extubation, and in the post-anaesthesia care unit. The study aimed to determine whether this simple nutritional intervention could improve metabolic preparedness and reduce anaerobic stress in living liver donors.

Prolonged preoperative fasting induces peripheral insulin resistance, glycogen depletion, and a catabolic metabolic state that predisposes patients to anaerobic metabolism during major surgery. Donor hepatectomy is a physiologically demanding procedure associated with significant ischaemia-reperfusion stress and an inherent risk of perioperative lactate accumulation. Preoperative carbohydrate loading has been proposed as a simple nutritional intervention to attenuate fasting-related metabolic stress by preserving glycogen stores and improving insulin sensitivity. However, its specific effect on serum lactate levels in living liver donors undergoing donor hepatectomy remains underexplored. This prospective randomized controlled trial was conducted at the Department of Anaesthesiology, Shifa International Hospital, Islamabad. Seventy adult patients aged 18-50 years scheduled for elective donor hepatectomy were enrolled and randomized into two equal groups. The intervention group received a standardized oral carbohydrate drink (maltodextrin solution) 2-4 hours before surgery, while the control group underwent standard preoperative fasting. Serum lactate levels were measured at five perioperative time points. Between-group comparisons were performed using the Mann-Whitney U test, and temporal trends were assessed using repeated measures ANOVA.