Maltodextrin Versus Sugar Water Carbohydrate Loading and Gastric Volume in Geriatric Lower Limb Orthopedic Surgery

Before surgery, patients are asked to fast so the stomach is empty and stomach contents cannot enter the lungs during anesthesia. Long fasting is uncomfortable and can raise blood sugar and stress responses in older adults. Giving a carbohydrate drink up to 2 hours before surgery is part of enhanced recovery (ERAS) programs. It is not clear whether a maltodextrin drink or sugar water leaves less fluid in the stomach of older patients. This randomized, double-blind study enrolls patients aged 60 years and older who are having elective lower limb orthopedic surgery under spinal or epidural anesthesia at Prof. Ngoerah General Hospital in Denpasar, Indonesia. Participants are assigned by chance to drink 400 mL of either a maltodextrin carbohydrate drink or sugar water 2 hours before anesthesia. The amount of fluid in the stomach is measured with bedside ultrasound before the drink and 2 hours after it. Blood glucose is measured before the drink, 2 hours after it and 6 hours after surgery. The neutrophil-lymphocyte ratio, a blood marker of inflammatory stress, is compared before surgery and 6 hours after surgery. The results are intended to show which drink is better suited to older surgical patients and to support safer and more comfortable fasting practice.