practices that optimize patient care, says Dr. Wahr. For example, Dr.
Wahr, who refuses to name names, says some surgeons she works with
are notorious for thinking they operate faster than they actually do. Go
figure.
The surgeons are worried that moving their cases up from their sched-
uled time endangers patients who drink clear fluids under the assump-
tion that their cases would start later. That concern isn't enough to
ignore a significant improvement in patient care, according to Dr. Wahr,
who says surgeons aren't often ahead of schedule in her facility. "Moving
their cases up happens about 5% of the time," she says.
She suggests removing NPO after midnight from your surgical
orders. If surgeons resist, she says, politely listen, address their con-
cerns with clinical data that backs the practice of pre-op fluid con-
sumption and carry on with your day.
Healthy sips
There are 2 main reasons for letting patients drink 2 hours before sur-
gery — to keep patients hydrated and comfortable, and to optimize
outcomes.
• Hydration. Pulp-free fruit juices, sports drinks, water and even
black coffee keep patients hydrated and comfortable. Consider that a
liter of normal saline IV solution contains 9 grams of salt. Is it any
wonder your patients can easily become dehydrated during surgery?
"Thirst is a powerful primitive drive," says Dr. Wahr. "It can be physi-
cally painful not to drink."
• Outcomes. Carb-rich, pre-surgery drinks have the added potential
of optimizing outcomes. Drinks that contain at least 50 g of carbohy-
drates — especially those containing the complex carbohydrate mal-
todextrin — have been proven to decrease insulin resistance, which
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