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Archive December 2019 XX, No. 12

Why Fast Past Midnight?

Patients who carbo-load before procedures can better handle the physical stress of surgery and recover sooner.

Daniel Cook

Daniel Cook, Editor-in-Chief



TIME FOR CHANGE Patients who fast during the hours leading up to surgery enter the OR in a nutritionally replete state.

No food or drink past midnight is slowly giving way to carbo-loading up to 2 hours before surgery. Fasting past midnight has been an unwritten Ordinance of the OR for almost 75 years. We can trace its origins to an obstetrician and cardiologist named Curtis Mendelson, who in 1946 reported in an influential study that you could avoid aspiration during general anesthesia for delivery by restricting oral intake during labor.

“Pre-op fasting is a concept that’s been ingrained in surgeons and anesthesiologists since medical school,” says Gregg Nelson, MD, PhD, FRCSC, a professor at the Tom Baker Cancer Centre in Calgary, Alberta, Canada. “But in reality, the practice isn’t supported by evidence. In fact, evidence shows it may result in patient harm.”

A fasting state — when food has been completely digested and stored — occurs as soon as 4 hours after eating and can lead to post-op insulin resistance, hyperglycemia and dehydration. On the other hand, patients who carbohydrate load by drinking 50 g of maltodextrin reconstituted in a clear liquid or pre-surgery complex-carbohydrate drinks up to 2 hours before surgery are more physically prepared to endure the rigors of surgery.

Their blood glucose and blood pressure levels are stable, and they’re less likely to experience insulin resistance from the stress of surgery. They’ll also be in less pain and at lower risk of suffering post-op infections — factors that impact patient satisfaction and lead to better outcomes. You also can’t ignore the importance of improving the patient experience. Patients who consume a formulated drink before arriving for surgery feel fuller and hydrated, and therefore more comfortable and potentially less anxious.

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