like they've run multiple marathons? Efforts to optimize their pre-op
nutrition should begin with putting one of surgery's sacred cows out to
pasture.
NPO.
Asking your patients to go NPO after midnight is an antiquated
approach. Patients who drink carbohydrate supplements 2 to 3 hours
before surgery show up at your facility feeling less anxious and less
irritable because they're hydrated and nourished. After surgery,
they're less likely to be nauseated and vomiting. They experience less
pain, recover faster and head home sooner. Their blood sugar levels
are stabilized, so they don't become hyperglycemic or hypoglycemic,
which decreases their risk of infection. Also consider that complica-
tion rates increase from 29% in well-nourished patients to 72% in mal-
nourished patients, according to a study in Current Opinion in
Anesthesiology (osmag.net/ruFTZ3). The study also found that mal-
nourished patients are 3 times more likely to suffer post-op complica-
tions and up to 5 times more likely to die after surgery.
Drink 2 hours before
Enhanced Recovery After Surgery (ERAS) protocols recommend hav-
ing patients drink a carb-rich formula 2 hours before surgery.
Guidelines issued by the American Society of Anesthesiology have
stated for more than a decade that patients can drink clear liquids up
to 2 hours before induction of anesthesia. Current guidelines don't
need to be changed. We just need to communicate the benefit of drink-
ing carb-loaded drinks to providers and patients.
The problem is surgeons and anesthesia providers are set in their
ways and have often not told patients to forgo going NPO for the many
hours that are common now. They also haven't had easy-to-use prod-
ucts available to keep patients hydrated and nourished on the day of
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