Effectiveness and safety of preoperative carbohydrate loading in pediatric patients: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE To evaluate the efficacy and safety of preoperative carbohydrate loading (PCL) in pediatric patients.

METHODS Following PRISMA 2020 guidelines, randomized controlled trials (RCTs) comparing PCL with fasting or placebo in patients aged ≤18 years were searched across nine databases up to July 9, 2025. Outcomes included behavioral indices (anxiety, sedation, and mask acceptance), metabolic parameters (postoperative blood glucose, insulin, and insulin resistance), and postoperative nausea and vomiting (PONV). Data were pooled using a random-effects meta-analysis model, and sensitivity analyses were conducted.

RESULTS This meta-analysis of 14 RCTs (1428 pediatric patients) demonstrates that PCL provides multidimensional benefits for pediatric patients. It effectively improves cooperation during anesthesia induction (reducing anxiety and enhancing sedation) and stabilizes metabolic status (the compound carbohydrate solution reduces postoperative insulin levels and insulin resistance). Furthermore, PCL significantly reduces the incidence of PONV, with a pronounced preventive effect against moderate-to-severe episodes. Notably, while a standard carbohydrate solution carries a risk of elevating postoperative blood glucose, the compound carbohydrate solution demonstrates a more favorable metabolic safety profile.

CONCLUSION PCL provides multifaceted benefits in pediatric surgery. Different solution types are associated with distinct metabolic effect patterns, a factor warranting consideration in clinical application.