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Anesthesiology Feb 2023These practice guidelines are a modular update of the "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary...
2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative...
These practice guidelines are a modular update of the "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." The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.
Topics: Humans; Child; Chewing Gum; Anesthesiologists; Preoperative Care; Fasting; Elective Surgical Procedures
PubMed: 36629465
DOI: 10.1097/ALN.0000000000004381 -
Anesthesiology Dec 2015Surgery represents a major stressor that disrupts homeostasis and can lead to loss of body cell mass. Integrated, multidisciplinary medical strategies, including... (Review)
Review
Surgery represents a major stressor that disrupts homeostasis and can lead to loss of body cell mass. Integrated, multidisciplinary medical strategies, including enhanced recovery programs and perioperative nutrition support, can mitigate the surgically induced metabolic response, promoting optimal patient recovery following major surgery. Clinical therapies should identify those who are poorly nourished before surgery and aim to attenuate catabolism while preserving the processes that promote recovery and immunoprotection after surgery. This review will address the impact of surgery on intermediary metabolism and describe the clinical consequences that ensue. It will also focus on the role of perioperative nutrition, including preoperative nutrition risk, carbohydrate loading, and early initiation of oral feeding (centered on macronutrients) in modulating surgical stress, as well as highlight the contribution of the anesthesiologist to nutritional care. Emerging therapeutic concepts such as preoperative glycemic control and prehabilitation will be discussed.
Topics: Humans; Nutritional Status; Nutritional Support; Perioperative Care; Postoperative Complications; Preoperative Care; Surgical Procedures, Operative
PubMed: 26248016
DOI: 10.1097/ALN.0000000000000795 -
Anesthesiology Mar 2017
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 Task Force on Preoperative Fasting and the Use...
Topics: Advisory Committees; Anesthesiologists; Antiemetics; Elective Surgical Procedures; Fasting; Humans; Preoperative Care; Reference Values; Respiratory Aspiration; Risk; Societies, Medical; United States
PubMed: 28045707
DOI: 10.1097/ALN.0000000000001452 -
Anaesthesia Jan 2019It is widely recognised that prolonged fasting for elective surgery in both children and adults serves no purpose, adversely affects patient well-being and can be... (Review)
Review
It is widely recognised that prolonged fasting for elective surgery in both children and adults serves no purpose, adversely affects patient well-being and can be detrimental. Although advised fasting times for solids remain unchanged, there is good evidence to support a 1-h fast for children, with no increase in risk of pulmonary aspiration. In adults, a major focus has been the introduction of carbohydrate loading before anaesthesia, so that patients arrive for surgery not only hydrated but also in a more normal metabolic state. The latter attenuates some of the physiological responses to surgery, such as insulin resistance. As in children, there is no increase in risk of pulmonary aspiration. Further data are required to guide best practice in patients with diabetes.
Topics: Adult; Child; Elective Surgical Procedures; Fasting; Guidelines as Topic; Humans; Practice Guidelines as Topic; Preoperative Care; Preoperative Period
PubMed: 30500064
DOI: 10.1111/anae.14500 -
Anaesthesia Jan 2019Pre-operative nutrition therapy is increasingly recognised as an essential component of surgical care. The present review has been formatted using Simon Sinek's Golden... (Review)
Review
Pre-operative nutrition therapy is increasingly recognised as an essential component of surgical care. The present review has been formatted using Simon Sinek's Golden Circle approach to explain 'why' avoiding pre-operative malnutrition and supporting protein anabolism are important goals for the elective surgical patient, 'how' peri-operative malnutrition develops leading in part to a requirement for pre-operative anabolic preparation, and 'what' can be done to avoid pre-operative malnutrition and support anabolism for optimal recovery.
Topics: Elective Surgical Procedures; Humans; Nutritional Status; Preoperative Care
PubMed: 30604414
DOI: 10.1111/anae.14506 -
Jornal de Pediatria 2019To verify the effect of psychological preparation on the relief of preoperative anxiety in children and to correlate parents' and children's levels of anxiety. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To verify the effect of psychological preparation on the relief of preoperative anxiety in children and to correlate parents' and children's levels of anxiety.
METHOD
After the approval of the institutional Research Ethics Committee and written consent of the children's parents or guardians, 118 children of both genders were prospectively selected, aged between 2 and 8 years, physical condition classification ASA I, who were treated in the pre-anesthetic evaluation ambulatory of the University Hospital and who underwent ambulatory surgeries at the same hospital. Two controlled groups of 59 children were randomized: control group basic preparation and psychological preparation group. On the day of surgery, all selected children were evaluated regarding their level of anxiety using the modified Yale Preoperative Anxiety Scale and their parents were evaluated regarding their level of anxiety through the Visual Analog Scale. The evaluator was blinded to which study group the child and family member belonged to.
RESULTS
Nine children and their family members were excluded per group when the results were analyzed. Children from the prepared group showed significant reductions in their level of anxiety in relation to the control group (p=0.04). There was no correlation between the level of anxiety of children and their parents' levels (p=0.78).
CONCLUSION
The psychological preparation was effective in reducing the level of anxiety of children. However, there was no relation between the level of anxiety of children and their parents' level.
Topics: Anxiety; Child; Child, Preschool; Double-Blind Method; Female; Humans; Male; Parents; Preoperative Care; Preoperative Period; Prospective Studies; Statistics, Nonparametric; Treatment Outcome; Visual Analog Scale
PubMed: 31340899
DOI: 10.1016/j.jped.2018.05.009 -
Medical Archives (Sarajevo, Bosnia and... Dec 2018Osteoarthritis (OA) is the most common joint disease in the world. At the end stage of the disease, usually when patients cannot handle the pain anymore, the knee... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Osteoarthritis (OA) is the most common joint disease in the world. At the end stage of the disease, usually when patients cannot handle the pain anymore, the knee replacement surgery is the most common and effective treatment to reduce pain and improve functionality. The effect of preoperative exercise (prehabilitation) for patients undergoing total knee arthroplasty (TKA) is still controversial.
AIM
To investigate the effect of prehabilitation on postoperative outcome and compare the results of the intervention with the control group.
MATERIAL AND METHODS
This prospective study included 20 patients with a diagnosis of gonarthrosis, aged 48-70, who were randomly allocated to either the intervention group or control. Ten patients (intervention group) underwent a 6-week home-based exercise program before the TKA surgery. All patients were assessed by Knee Score (KS), Function Score (FS), and Body Mass Index (BMI) according to the following schedule: 6 weeks before surgery (for intervention group it meant before the prehabilitation program), just prior to surgery (for intervention group it meant after the prehabilitation program), after the surgery, at 3 month, 6 month, and 12 month postoperatively. They were all operated by the same surgeon, for the primary total knee replacement (Zimmer NexGen Complete Knee Solution) at the Clinic for Orthopaedics and Traumatology, Clinical Centre University of Sarajevo, from October 2016 to June 2017.
RESULTS
There is statistically significant difference for Knee and Function Score between the intervention and control group in testing time: just before surgery-meaning that KS and FS increased after the prehabilitation program. Knee Score was significantly different between the two observed groups postoperatively, 3 months postoperatively and 6 months postoperatively, while the Function Score was not significantly different in that period. Prehabilitation program provides better preoperative KS and FS, and better KS up to 6 months postoperatively. However, 12 months postoperatively there was no significant difference between the intervention and control group for the Knee and Function Score.
CONCLUSION
Prehabilitation brings significant difference regarding the Knee Score in favor of the intervention group preoperatively and up to 6 months postoperatively.
Topics: Aged; Arthroplasty, Replacement, Knee; Exercise Therapy; Female; Humans; Male; Middle Aged; Osteoarthritis, Knee; Postoperative Period; Preoperative Care; Prospective Studies; Range of Motion, Articular; Recovery of Function; Time Factors; Treatment Outcome
PubMed: 30814777
DOI: 10.5455/medarh.2018.72.439-443 -
The Journal of International Medical... May 2024The aging world population obliges physicians to establish measures to optimize and estimate the outcomes of increasingly frail patients. Thus, in the last few years... (Review)
Review
The aging world population obliges physicians to establish measures to optimize and estimate the outcomes of increasingly frail patients. Thus, in the last few years there has been an increase in the application of frailty indices. Multiple scales have emerged that can be applied in the perioperative setting. Each one has demonstrated some utility, either by way of establishing postoperative prognosis or as a method for the clinical optimization of patient care. Anaesthesiologists are offered a wide choice of scales, the characteristics and appropriate management of which they are often unaware. This narrative review aims to clarify the concept of frailty, describe its importance in the perioperative setting and evaluate the different scales that are most applicable to the perioperative setting. It will also establish paths for the future optimization of patient care.
Topics: Humans; Frailty; Geriatric Assessment; Aged; Frail Elderly; Prognosis; Preoperative Care; Preoperative Period
PubMed: 38818532
DOI: 10.1177/03000605241251705 -
Ugeskrift For Laeger Jan 2024With an increasing aging population, there will be a greater need for cancer evaluation and treatment in older patients. Age alone is not a good predictor of... (Review)
Review
With an increasing aging population, there will be a greater need for cancer evaluation and treatment in older patients. Age alone is not a good predictor of postoperative morbidity, and a multidisciplinary approach is crucial for managing comorbidities. Preoperative optimisation, such as prehabilitation, may in some cases reduce postoperative complications, and minimal invasive techniques should be preferred whenever possible. In general, as summarised in this review, cancer treatment in older patients should be individualised based on comorbidities and life expectancy.
Topics: Humans; Aged; Preoperative Care; Postoperative Complications; Neoplasms; Aging; Morbidity
PubMed: 38305320
DOI: 10.61409/V08230489 -
JAMA Surgery Mar 2023Current fasting guidelines for procedures under anesthesia are poorly implemented, leading to negative metabolic sequelae. Recent studies in children showed support of...
IMPORTANCE
Current fasting guidelines for procedures under anesthesia are poorly implemented, leading to negative metabolic sequelae. Recent studies in children showed support of liberal clear fluid intake; adult physiology can support clear fluid intake, but implementation studies are lacking.
OBJECTIVE
To evaluate the successfulness of implementation of a liberal clear fluid policy with regard to fasting duration, well-being, and safety in adults scheduled for anesthesia.
DESIGN, SETTING, AND PARTICIPANTS
This was a quality improvement study conducted from January 2016 to July 2021 at a tertiary referral hospital in the Netherlands. Adults scheduled for nonemergency procedures under anesthesia were included in the study. Patients undergoing obstetrics procedures or those who were intubated preoperatively were excluded.
INTERVENTIONS
Stepwise introduction of a liberal fluid fasting policy, allowing for ingestion of clear fluids until arrival at the operating room.
MAIN OUTCOMES AND MEASURES
The primary outcome was change in fasting duration. Secondary outcomes were patient well-being, measured as preoperative thirst, amount of fluid ingested, postoperative nausea and vomiting (PONV), and administration of antiemetics. Safety was measured as incidence of regurgitation and aspiration (pneumonia).
RESULTS
Of the 76 451 patients (mean [SD] age, 56 [17] years; 39 530 male individuals [52%] 36 921) included in the study, 59 036 (78%) followed the standard policy, and 16 815 (22%) followed the liberal policy. Time series analysis showed an estimated fasting duration decrease of 3:07 hours (IQR, 1:36-7:22; P < .001) after implementation of the liberal policy. Postimplementation median (IQR) fasting duration was 1:20 (0:48-2:24) hours. The incidence of regurgitation changed from 18 (95% CI, 14-21) to 24 (95% CI, 17-32) in 10 000 patients, and the incidence of aspiration changed from 1.7 (95% CI, 0.6-2.7) to 2.4 (95% CI, 0.5-4.7) in 10 000 patients. In the liberal policy, thirst feelings decreased (37% [4982 of 8615] vs 46% [3373 of 7362]; P < .001). PONV incidence decreased from 10.6% (6339 of 59 636) to 9.4% (1587 of 16 815; P < .001) and antiemetic administration decreased from 11.0% (6538 of 59 636) to 9.5% (1592 of 16 815; P < .001).
CONCLUSIONS AND RELEVANCE
Results of this quality improvement study suggest that a liberal fasting policy was associated with a clinically relevant reduction in fasting duration and improved patient well-being with regard to preoperative thirst and PONV. Although a slightly higher incidence of regurgitation could not be ruled out, wider implementation of such a policy may be advocated as results are still within the clinically accepted risks margins. Results suggest that surgical procedures in patients who drink clear fluids within 2 hours before anticipated anesthesia should not be postponed or canceled.
Topics: Child; Adult; Humans; Male; Middle Aged; Postoperative Nausea and Vomiting; Preoperative Care; Fasting; Anesthesia; Pneumonia, Aspiration
PubMed: 36598762
DOI: 10.1001/jamasurg.2022.5867