[Preoperative fasting period of fluids in bariatric surgery].

BACKROUND

Aspiration of stomach content is a severe complication during general anaesthesia. The DGAI (German Society for Anesthesiology and Intensive Care Medicine) guidelines recommend a fasting period for liquids of 2 h, with a maximum of 400 ml. Preoperative fasting can affect the patients' recovery after surgery due to insulin resistance and higher protein catabolism as a response to surgical stress.

OBJECTIVES

The aim of the study was to compare a liberal fasting regimen consisting of up to 1000 ml of liquids until 2 h before surgery with the DGAI recommendation.

MATERIALS AND METHODS

The prospective observational clinical study was approved by the ethics committee of the University of Leipzig. In the liberal fasting group (G) patients undergoing bariatric surgery were asked to drink 1000 ml of tea up to 2 h before surgery. Patients assigned to the restrictive fasting group (G) who were undergoing nonbariatric abdominal surgery were asked to drink no more than 400 ml of water up to 2 h preoperatively. Right after anaesthesia induction and intubation a gastric tube was placed, gastric residual volume was measured and the pH level of gastric fluid was determined. Moreover, the occurrence of aspiration was monitored.

RESULTS

In all, 98 patients with a body mass index (BMI) of G 51.1 kg/m and G 26.5 kg/m were identified. The preoperative fasting period of liquids was significantly different (G 170 min vs. G 700 min, p < 0.001). There was no difference regarding the residual gastric volume (G 11 ml, G 5 ml, p = 0.355). The pH of gastric fluid was nearly similar (G 4.0; G 3.0; p = 0.864). Aspiration did not occur in any patient.

CONCLUSIONS

There is evidence suggesting that a liberal fluid fasting regimen (1000 ml of fluid) in the preoperative period is safe in patients undergoing bariatric surgery.