Preoperative Nutrition and Prehabilitation

Gupta R, Gan TJ. Preoperative Nutrition and Prehabilitation. Anesthesiol Clin. 2016 Mar;34(1):143-53.

What is already known:

Preoperative nutrition and prehabilitation are two potentially important interventions in preparing patients for surgery.

What this paper adds:

Comprehensive review on preoperative nutrition – including assessment and optimisation, immunonutrition and how to avoid insulin resistance. And prehabilitation – including assessment (e.g. cardiopulmonary exercise tests and 6-minute walk tests) and exercise programs.

Chris Jones, Guildford.


Starvation, carbohydrate loading, and outcome after major surgery

William J Fawcett, Olle Ljungqvist, BJA Education, Volume 17, Issue 9, 1 September 2017, Pages 312–316,

What is already known:

Preoperative carbohydrate loading has long been an essential part of a successful ERAS programme, where it modifies insulin resistance, improves patient comfort and wellbeing, minimises protein losses, and improves postoperative muscle function.

What this paper adds:

This excellent review written by two executive committee members of the ERAS Society explores the metabolic changes and stress response following major surgery, the mechanism by which insulin resistance arises. They summarise the evidence behind carbohydrate loading, and in particular explores the more controversial use in patients with diabetes.

Chris Jones, Guildford.