Effect of Preoperative Maltodextrin on Cortisol Regulation in ERACS: A Randomized Controlled Trial

Caesarean section (CS) induces significant surgical stress, triggering cortisol elevation and insulin resistance, which can impair recovery. Prolonged fasting further exacerbates metabolic stress, compounding these physiological challenges. To counteract these effects, the Enhanced Recovery after Caesarean Surgery (ERACS) protocol recommends preoperative carbohydrate loading as a strategy to mitigate surgical stress and support metabolic stability. Among the available carbohydrate options, maltodextrin—a glucose polymer—has gained attention for its ability to regulate cortisol levels and enhance perioperative metabolic function. However, evidence regarding its effectiveness in CS patients remains limited. This study aims to evaluate the impact of preoperative maltodextrin administration on postoperative cortisol levels in CS patients. A randomized controlled trial was conducted involving ۲۰ elective ERACS patients randomly assigned to a control (۶-hour fasting) or intervention (۵۰ g maltodextrin ۱۵% in ۴۰۰ mL water, ۲ hours preoperatively) group. Serum cortisol levels were measured preoperatively and ۲ hours postoperatively. Data were analysed using SPSS v۲۷.۰, with t-tests or non-parametric equivalents. Ethical approval was obtained, and informed consent was secured from all participants. Baseline characteristics, including age, body mass index, gestational age, operation duration, and preoperative blood glucose and cortisol levels, were similar between groups (p > ۰.۰۵). Postoperative cortisol levels were significantly lower in the intervention group (۶.۵۱ ± ۱.۱۴ vs. ۸.۵۲ ± ۱.۳۲ mcg/dL; p = ۰.۰۰۲). Both groups showed a decline in cortisol levels postoperatively, but the reduction was greater in the intervention group (-۳.۵۷ ± ۱.۷۴ vs. -۱.۴۲ ± ۱.۰۲ mcg/dL; p = ۰.۰۰۴). Preoperative maltodextrin administration effectively attenuates the surgical stress response by reducing postoperative cortisol levels, supporting its role in ERACS protocols.

کلیدواژه ها:

Cesarean section ، cortisol ، ERACS ، Maltodextrin ، preoperative carbohydrate