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Key Points

Key Points for Medical Professionals

1. SAFE: Current Anesthesia Society (1) guidelines allow pre-surgical patients to safely ingest clear liquids like SurgiStrong RecoverAid™ up until 2 hours before anesthesia. Safe for Celiac Sprue and patient with food allergies. Diabetic patients use under direction of physician.

2. Patient Comfort: Clear liquids before surgery can improve patient comfort. (2)

3. Proven Benefits: Preoperative carbohydrate loading using a product like SurgiStrong RecoverAid™ can reduce post-surgical insulin resistance and protein losses, has been shown to reduce post-operative length of stay, and is part of several enhanced recovery after surgery (ERAS) protocols.
It has been standard practice in the United States to have patients fast from midnight the night before a surgical procedure. This dogmatic practice is not supported by available evidence and is not in line with current pre-operative guidelines. Extended pre-surgical fasting causes patient discomfort and anxiety, does NOT reduce the risk of aspiration, and PREVENTS preoperative carbohydrate loading, an important piece of enhanced recovery protocols.

Preoperative Carbohydrate Loading

In addition to nutrition and fitness, a patient’s metabolic state is another important target for optimization. The ability to recover from hemorrhage and sepsis is improved in the fed state. (6) A key component of this is insulin resistance, which is increased during the fasting state and can lead to hyperglycemia (7), a well-known risk factor for many poor surgical outcomes. Studies utilizing carbohydrates in the pre-op setting to revert to a fed state have found less protein loss and a 50% reduction in insulin resistance postoperatively. (6,8,9) This practice has become an integral component of ERAS (Enhanced Recovery After Surgery) protocols across the globe.

It has been standard practice in the United States to have patients fast from midnight the night before a surgical procedure. This dogmatic practice is not supported by available evidence and is not in line with current pre-operative guidelines. Extended pre-surgical fasting causes patient discomfort and anxiety, does NOT reduce the risk of aspiration, and PREVENTS preoperative carbohydrate loading, an important piece of enhanced recovery protocols.

SurgiStrong RecoverAid™ provides the carbohydrates needed to optimize patient recovery

Other benefits of preoperative carbohydrate loading include preservation of skeletal muscle mass (10) and improved postoperative muscle function. (11) A recent meta-analysis of randomized trials found preoperative oral carbohydrate treatment may be associated with reduced length of stay in patients undergoing major abdominal surgery. (12) Finally, a Cochrane review found that preoperative carbohydrate treatment compared with placebo or fasting resulted in a reduced length of stay. (13)

The Bottom Line

Preoperative guidelines allow ingestion of clear liquids up until 2 hours prior to anesthesia. The addition of SurgiStrong RecoverAid™ to your preoperative protocols is an inexpensive way to improve patient satisfaction and optimize them for surgery.

References

1. ASA Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011 Mar;114(3):495-511.

2. Madsen M, Brosnan J, Nagy VT. Perioperative thirst: a patient perspective. J Perianesth Nurs. 1998 Aug;13(4):225-8.

3. Maltby JR, Sutherland AD, Sale JP, Shaffer EA. Preoperative oral fluids: is a five-hour fast justified prior to elective surgery? Anesth Analg. 1986 Nov;65(11):1112-6.

4. Goresky GV, Maltby JR. Fasting guidelines for elective surgical patients. Can J Anaesth. 1990 Jul;37(5):493-5.

5. Søreide E, Fasting S, Raeder J. New preoperative fasting guidelines in Norway. Acta Anaesthesiol Scand. 1997 Jun;41(6):799.

6. Ljungqvist O. Modulating postoperative insulin resistance by preoperative carbohydrate loading. Best Pract Res Clin Anaesthesiol. 2009 Dec;23(4):401-9.

7. Gillis C, Carli F. Promoting Perioperative Metabolic and Nutritional Care. Anesthesiology. 2015 Dec;123(6):1455-72.

8. Ljungqvist O, Thorell A, Gutniak M, Häggmark T, Efendic S. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance. J Am Coll Surg. 1994 Apr;178(4):329-36.

9. Nygren J, Thorell A, Jacobsson H, Larsson S, Schnell PO, Hylén L, Ljungqvist O. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg. 1995 Dec;222(6):728-34.

10. Yuill KA1, Richardson RA, Davidson HI, Garden OJ, Parks RW. The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively–a randomized clinical trial. Clin Nutr. 2005 Feb;24(1):32-

11. Henriksen, MG, Hansen, HV, Dela, F, Haraldsted, V, Rodt, SA, Hessov, I. Preoperative feeding might improve postoperative voluntary muscle function. Clin Nutr. 1999;18:82.

12. Awad S1, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr. 2013 Feb;32(1):34-44.

13. Smith MD1, McCall J, Plank L, Herbison GP, Soop M, Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev. 2014 Aug 14;(8)

14. Melis et al. A carbohydrate-rich beverage prior to surgery prevents surgery-induced immunodepression: a randomized, controlled, clinical trial. JPEN J Parenter Enteral Nutr. 2006 Jan-Feb;30(1):21-6. retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16387895

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