Alternating concepts in preoperative fasting

Abstract

Elective surgery is performed on approximately 5% of the population in developed countries. The operation is usually performed in the overnight fasted state, called ''Nil Per Os''. However this fasting causes both physical and metabolic stress like dehydration, anxiety and particularly insulin resistance.

Postoperative insulin resistance causes hyperglicemia and defects on wound healing which results as a longer hospitalization period. This increases both morbidity and cost. In order to prevent the postoperative insulin resistance, researches are focused on alternative regimens instead of Nil Per Os application. Although feeding before general anesthesia increases the risk of aspiration, recent studies showed that especially clear liquids can safely be allowed 2 hours prior to surgery. On the other hand clear liquids do not prevent the metabolic effects of fasting. These studies include the development of a carbohydrate rich drink which has been tested and showed to be safe in the preoperative situation. By means of this liquid preoperative insulin resistance, dehydration, anxiety and hospitalization period are decreased and the well being state of the patient is increased significantly.

Regarding to recent changes set in many countries, we should revise our own preoperative fasting regimens for more beneficial strategies.