ANESTHESIA ALERT
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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U LY 2 0 1 4
who traditionally fasted. Actually, several peer-reviewed trials have
demonstrated the exact opposite: the resultant RGVs and RGAs are equal
to or less than those found in patients who fasted from midnight.
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Fear of cancellation.
There is the economic concern that letting
patients drink up to 2 hours before surgery could compromise the effi-
ciencies of the surgery schedule. An example might include the cancel-
lation, for any reason, of a procedure in a busy surgeon's lineup and the
inability to move up a subsequent procedure because that patient
would not have fasted for the requisite 2 hours after consuming a clear
liquid.
The new pre-operative fast
Over the last several years, a new paradigm of perioperative patient
care, Enhanced Recovery After Surgery (ERAS), has swept Europe
and the U.K., finally arriving in the United States over the last year or
so. The protocol consists of 17 evidence-based care elements that,
when implemented, have reduced the incidence of several post-op
complications with the results of reduced length of stays in and re-
admissions to hospitals. Pre-op loading with carbohydrate-rich bever-
ages (12% concentration of complex carbohydrates) 2 hours before
anesthesia puts the patients in a metabolically fed state. Such loading
was found to be an independent predictor of post-op clinical out-
comes, including post-op nausea and vomiting. Further, it was viewed
as beneficial in the reduction of the post-operative insulin resistance
that is seen in both non-diabetics and diabetics and that leads to
hyperglycemia and surgical wound infections.
In truth, there's nothing magic about fasting from midnight for healthy
patients undergoing elective procedures. On the contrary, that dated prac-
tice could be placing patients at risk, unnecessarily, for the very conse-
quences that inspired the fasting rule: regurgitation and aspiration. At the
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