De Jonghe B, Fajardy A, Mérian-Brosse L, Fauconnier A, Chouillard E, Debit N, Solus H, Tabary N, Séguier J-C, Melchior J-C
Centre Hospitalier de Poissy-Saint-Germain, Poissy, France.
Hôpital Raymond Poincaré, APHP, Garches, France.
Acta Anaesthesiol Scand. 2016 Oct;60(9):1222-9. doi: 10.1111/aas.12756. Epub 2016 Jun 26.
The need to preserve operating room (OR) scheduling flexibility can challenge adherence to the 2-h pre-operative fasting period recommendation before elective surgery. Our primary objective was to assess the feasibility of a pre-operative carbohydrate (CHO) drink delivery strategy preserving OR scheduling flexibility.
During the 1st study phase, patients admitted for elective surgery fasted overnight (Control group); during the 2nd phase, patients fasted overnight and received a pre-operative CHO drink (CHO group). CHO delivery time was set to allow any patient to be ready for surgery 30 min ahead of the scheduled time and any patient with an operation scheduled in the afternoon to be ready at 13:00 hours; patients admitted the morning of an early morning operation would not be allowed to take a CHO drink.
We included 194 patients in the Control group and 199 in the CHO group. In the CHO group, the morning CHO dose was delivered to 66.3% of the patients (95% CI 59.3-72.9%), with a median pre-operative fasting time period of 4 h 57 min. After excluding patients admitted the morning of an operation scheduled before 10:00 hours, the delivery rate was 77.2% (70.2-83.3%). Patients in the CHO group experienced significantly less pre-operative thirst (median 2 vs. 5 on a 0-10 scale, P < 0.0001) and hunger (0 vs. 2, P < 0.0001) than those in the Control group.
Although preservation of OR scheduling flexibility resulted in a longer fasting time than recommended, CHO drink can be made available to a large proportion of patients with significantly reduced perioperative discomfort.
保持手术室（OR）排班灵活性的需求可能会对择期手术前遵循2小时术前禁食期的建议构成挑战。我们的主要目标是评估一种术前碳水化合物（CHO）饮料供应策略在保持手术室排班灵活性方面的可行性。
在第一个研究阶段，择期手术患者夜间禁食（对照组）；在第二阶段，患者夜间禁食并接受术前CHO饮料（CHO组）。CHO饮料的供应时间设定为让任何患者在预定时间前30分钟做好手术准备，以及让任何安排在下午手术的患者在13:00做好准备；清晨手术当天上午入院的患者不允许饮用CHO饮料。
我们纳入了194例对照组患者和199例CHO组患者。在CHO组中，66.3%的患者（95%CI 59.3 - 72.9%）在上午接受了CHO剂量，术前禁食时间中位数为4小时57分钟。排除上午10:00前安排手术当天上午入院的患者后，供应率为77.2%（70.2 - 83.3%）。CHO组患者术前口渴（0 - 10分制，中位数2分对5分，P < 0.0001）和饥饿感（0对2，P < 0.0001）明显低于对照组患者。
尽管保持手术室排班灵活性导致禁食时间比建议的更长，但CHO饮料可为很大一部分患者提供，且能显著减轻围手术期不适。
