Søreide Eldar, Ljungqvist Olle
Department of Anaesthesia, Division of Acute Care Medicine, Stavanger University Hospital, Stavanger, Norway.
Best Pract Res Clin Anaesthesiol. 2006 Sep;20(3):483-91. doi: 10.1016/j.bpa.2006.03.002.
This chapter is complementary to the others in this volume focusing on preoperative fasting routines. In it we discuss some of the issues in need of more research to define best practice. One of these is the role of fasting in emergency patients. Modern preoperative fasting recommendations almost exclusively deal with elective patients. In emergency patients preoperative fasting cannot secure gastric emptying to reduce the risk of pulmonary aspiration. Hence, surgery should be timed according to the urgency of the situation, and the patient should always be treated as if the stomach was full. More data are needed to better define what is going on in the gastrointestinal tract during the perioperative period in these patients. In certain patient groups--such as patients with diabetes, gastro-oesophageal reflux disease and/or obesity--the data are insufficient to give complete guidance to best practice. Preoperative fasting guidelines also affect fluid balance and perioperative fluid management, a topic of debate in recent years. In addition, carbohydrate-enriched fluids for oral use in the preoperative phase have been shown to have a positive effect on postoperative metabolism. Recent studies also suggest that the immune system would be less affected by surgery with such preparations. Last but not least, new scientific evidence alone is not enough to change daily practice. Active implementation of new evidence is also needed. To improve perioperative care, anaesthesiologists, surgeons and the nursing staff must work together.
本章是对本卷中其他关注术前禁食常规章节的补充。在本章中，我们讨论了一些需要更多研究以确定最佳实践的问题。其中之一是禁食在急诊患者中的作用。现代术前禁食建议几乎完全针对择期手术患者。对于急诊患者，术前禁食无法确保胃排空以降低肺误吸风险。因此，手术应根据病情紧急程度安排时间，并且应始终将患者视为胃是满的来进行治疗。需要更多数据来更好地界定这些患者围手术期胃肠道内的情况。在某些患者群体中，如糖尿病患者、胃食管反流病患者和/或肥胖患者，现有数据不足以提供关于最佳实践的完整指导。术前禁食指南还会影响液体平衡和围手术期液体管理，这是近年来备受争议的话题。此外，术前阶段口服富含碳水化合物的液体已被证明对术后代谢有积极影响。近期研究还表明，使用此类制剂进行手术对免疫系统的影响较小。最后但同样重要的是，仅有新的科学证据不足以改变日常实践。还需要积极实施新证据。为改善围手术期护理，麻醉医生、外科医生和护理人员必须共同努力。
