points out those
amounts can be
achieved by following
North American
Surgical Nutrition
Summit recommenda-
tions, which state that
patients, when appro-
priate based on their
health status, should
drink 800 ml of a
12.5% carbohydrate
drink the night before
surgery and 400 ml the
next morning two hours before anesthesia induction.
Many surgeons and anesthesia providers who are understandably
concerned about aspiration risks still stick to mandating six to eight
hours of preoperative fasting. Dr. Goldenberg points out, however,
that current clinical evidence does not show fasting for two to three
hours before surgery increases the risk of aspiration or morbidity
compared with the traditional approach of going NPO after mid-
night.
Dr. Goldenberg thinks long-established assumptions about going NPO
before surgery are beginning to change. When she helped launch an
ERAS program at Weill Cornell Medicine that allows patients to drink
clear fluids up to two hours before surgery, she received no pushback
from surgeons or anesthesia providers.
There's still work left to be done, however. Dr. Goldenberg has
spoken to peers across the country and has learned updated NPO
protocols are having trouble gaining traction because of pushback
M A R C H 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 7 9
• EXPERT ADVICE Melinda Yoder, RDN, CDN, meets with patients weeks before
their scheduled procedures and suggests healthy lifestyle changes that prepare their
bodies for the physical stress of surgery.
