Archive March 2018 XIX, No. 3

Eat, Drink and Be Healthy

Optimizing pre-op nutrition prepares patients for the physical stress of surgery, lowers risk of complications and improves clinical outcomes.

Paul Wischmeyer

Paul Wischmeyer, MD, EDIC

BIO

Got Carbs?
GOT CARBS? Pre-op carbohydrate drinks improve patient satisfaction by helping patients recover from surgery sooner and head home faster.

Marathoners eat and drink before races to make sure they're well-nourished and hydrated, but even that amount of preparation can't prevent their muscle glycogen levels — stores of energy in muscle —¬†from dropping from 90 (perfect) to 50 (average). That's nothing compared with what's endured by surgical patients, whose glycogen levels can drop to as low as zero after major procedures. If runners fuel their bodies to survive 26.2 grueling miles, why wouldn't you do the same for your patients, who leave the OR feeling 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 complication rates increase from 29% in well-nourished patients to 72% in malnourished patients, according to a study in Current Opinion in Anesthesiology osmag.net/ruFTZ3. The study also found that malnourished patients are 3 times more likely to suffer post-op complications and up to 5 times more likely to die after surgery.

Drink 2 hours before

Enhanced Recovery After Surgery (ERAS) protocols recommend having 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 drinking carb-loaded drinks to providers and patients.

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