Saller Thomas, Allmendinger Janine, Knabe Patricia, Knabe Max, Lenninger Lina, Just Anne-Marie, Seidenspinner Denise, Holzapfel Boris, Neuerburg Carl, Tomasi Roland
Department of Anaesthesiology, LMU Munich University Hospital Munich, 81377 Munich, Germany.
Max Planck Institute for the Study of Crime, Security and Law, 79100 Freiburg im Breisgau, Germany.
J Clin Med. 2025 Aug 4;14(15):5477. doi: 10.3390/jcm14155477.
The rationale for strict fluid fasting for pediatric and adult patients has been questioned recently. Point-of-care tools for the evaluation of gastric content have evolved over time, often using gastric ultrasound. Usually, the gastric antral cross-sectional area (CSA) is determined. A liberal fluid fasting regimen, that is, ingestion of liquid fluids until the call for theatre, does not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound. Anesthesia is safe, and no adverse events result from a liberal regimen. The ethics committee of LMU Munich approved the study (21-0903). Liberal fluid fasting in a geriatric orthopedic surgery department (LFFgertrud) is a sub-study within a project investigating perioperative neurocognitive disorders (Study Registration: DRKS00026801). After obtaining informed consent from 134 geriatric patients 70 years or older, we investigated the gastric antral cross-sectional area (CSA) prior to and postimplementation of liberal fluid management, respectively. After the implementation of liberal fluid fasting, fasting times for solid food and liquids decreased from 8.8 (±5.5) to 1.8 (±1.8) hours ( < 0.0001). In 39 patients where CSA was obtained, a slight increase in fluid was encountered. No critical amount of gastric content was observed, and no adverse events occurred. A liberal fluid fasting concept was safe even for comorbid elderly patients in orthopedic surgery. Applying a gastric ultrasound may be helpful to increase safety. According to the incidence of complications encountered in our study, it seems indispensable.
最近，儿科和成年患者严格禁水禁食的基本原理受到了质疑。随着时间的推移，用于评估胃内容物的床旁工具不断发展，通常采用胃超声检查。通常会测定胃窦横截面积（CSA）。与午夜禁食相比，宽松的禁水禁食方案，即直到手术通知前都可摄入液体，经胃超声评估不会延迟胃排空。麻醉是安全的，宽松方案不会导致不良事件。慕尼黑大学伦理委员会批准了该研究（21 - 0903）。老年骨科手术科室的宽松禁水禁食（LFFgertrud）是一项调查围手术期神经认知障碍项目中的子研究（研究注册号：DRKS00026801）。在获得134名70岁及以上老年患者的知情同意后，我们分别在实施宽松液体管理前后调查了胃窦横截面积（CSA）。实施宽松禁水禁食后，固体食物和液体的禁食时间从8.8（±5.5）小时降至1.8（±1.8）小时（<0.0001）。在39名获取了CSA的患者中，发现液体量略有增加。未观察到临界量的胃内容物，也未发生不良事件。即使对于骨科手术中合并症的老年患者，宽松的禁水禁食概念也是安全的。应用胃超声可能有助于提高安全性。根据我们研究中遇到的并发症发生率，这似乎是必不可少的。
