University Medical Center Utrecht
(Netherlands), published in
Nutrition in Clinical Practice and
provocatively titled "Enhanced
Recovery After Surgery: It's Time to
Change Practice!"
(osmag.net/eyMFN7), flatly states
that "traditional practices such as
prolonged pre-operative fasting (nil
by mouth from midnight), bowel
cleaning and reintroduction of oral nutrition 3-5 days after surgery are
being shunned." Touting optimization of pre-op nutrition, she con-
cludes, "As they challenge traditional surgical doctrine, the implementa-
tion of ERAS guidelines has been slow, despite the significant body of
evidence indicating that ERAS guidelines may lead to improved out-
comes."
Indeed, one of the more polarizing views on pre-op nutrition
involves the hours immediately leading up to surgery. Fasting up to 12
hours before surgery has been standard practice for many decades as
necessary for preventing complications from the administration of
anesthesia, such as aspiration and PONV. But it's not without its own
risks, and, as a result, perspectives on immediate pre-operative fasting
are changing in some quarters.
For example, another ASPEN study from January 2006, published in
its Journal of Parenteral and Enteral Nutrition, "A
Carbohydrate Rich Beverage Prior to Surgery Prevents
Surgery Induced Immunodepression: A Randomized, Controlled,
Clinical Trial" (osmag.net/Rv7APx), found that fasting before surgery
can actually induce post-operative insulin resistance, which is related
to infectious morbidity. The authors found that pre-operative intake of
M A R C H 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 5 1
Carbohydrate-
loading is a strategy
that's really
emerged for pre-op
optimization of
patients.
