Skip to main content
SpringerLink
Log in

Präoperative Flüssigkeitskarenz

Etablierung eines liberalen Flüssigkeitsregimes mittels Nüchternheitskarten

Preoperative fluid fasting

Establishment of a liberal fluid regimen using fasting cards

  • Originalien
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die präoperative Nüchternheit für klare Flüssigkeiten ist um ein Vielfaches länger, als von den Fachgesellschaften empfohlen. Ziel der Arbeit ist, ein liberales Flüssigkeitsregime zur präoperativen Karenz ausgewählter klarer Flüssigkeiten mittels standardisierter Nüchternheitskarten zu implementieren sowie erste Rückmeldungen zu dessen Umsetzung zu erheben.

Material und Methoden

Ein liberalisiertes Flüssigkeitsregime, welches das Trinken von Wasser, Apfelsaft, Tee und Kaffee bis zum Abruf in den OP erlaubt, wurde mittels Nüchternheitskarten implementiert. Acht Monate nach der Einführung erfolgte eine repräsentative Befragung der Leitungen chirurgischer Stationen zum Konzept.

Ergebnisse

Alle Stationsleitungen befürworten das Trinken klarer Flüssigkeiten bis zum Abruf in den OP, fast alle die Umsetzung dieses Konzeptes mittels Nüchternheitskarten. Neun von 11 Stationen empfinden die auf ihre Operation wartenden Patienten entspannter; eine i.v.-Flüssigkeitssubstitution wird seltener angefragt. Ausnahmslos alle Stationsleitungen möchten im Falle einer eigenen Operation nach dem neuen Nüchternheitskonzept behandelt werden.

Diskussion

Patienten sollte das Trinken von hypotonischen klaren Flüssigkeiten bis kurz vor der Operation erlaubt werden, um Komplikationen einer zu langen Nüchternheit zu vermeiden. Dabei sollte das Konzept klar strukturiert, für alle transparent, schriftlich fixiert und den Patienten ohne Sprachbarriere zur Kenntnis gebracht werden.

Abstract

Background

Preoperative fasting times for clear liquids surpass by far the recommendations of the specialist societies. The aim of this study was to introduce a liberal regimen for preoperative fasting of clear liquids using fasting cards as a training tool and to evaluate the implementation.

Material and methods

We developed a liberalized regimen of preoperative clear fluid fasting times, which allows patients to drink water, apple juice, tea and coffee until being called to the operating theatre. Each patient receives a bed-side fasting card with written information specifying fasting times for solid food and liquids. Patients who are allowed to drink water, apple juice, tea and coffee until the call to the operating theatre receive a blue fasting card. Patients with coexisting diseases or conditions that can affect gastric emptying or who need longer fasting times because of the surgical procedure get a yellow fasting card on which fasting times for fluids and solids can be documented individually. Patients who need to be nil per os (for example patients with ileus or bowel obstruction, emergency care) receive a red fasting card. On the back of the card the information is written in English, Turkish, Russian and Arabic. After a period of 8 months all surgical ward managers were asked to complete a questionnaire to assess the implementation of the new fasting regimen.

Results

The response rate of the questionnaire was 100%. Without exception all interviewees would recommend the use of our liberalized fasting regimen. Almost all would also support the implementation of fasting cards. Out of 11 wards 9 found that patients were more relaxed and asked for intravenous fluids less often while waiting for surgery. The multilingual nature of the cards makes it easier to deal with patients who do not speak German. All ward managers consistently approved the new regimen in the event they themselves would need an operation. In order to make the fasting cards also usable in the future for rescue centers and functional units, such as endoscopy, echo or cardiac catheters, the reasons for fasting on the blue and yellow cards have been extended to operation or examination and on the red card to illness, operation or upcoming examination.

Conclusion

Patients should be allowed to drink water and hypotonic clear fluids until shortly before an operation to avoid complications of overly long fasting times. Fasting cards help to implement this by providing easy to understand information for patients and healthcare workers. This concept should be clearly structured, transparent for everyone, written down and brought to the attention of the patient without a language barrier.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Allescher H‑D (2012) Motilitätsstörungen von Magen und Duodenum. In: Klin. Gastroenterol. Thieme, Stuttgart, S 223–229

    Google Scholar 

  2. Andersson H, Hellström PM, Frykholm P (2018) Introducing the 6‑4‑0 fasting regimen and the incidence of prolonged preoperative fasting in children. Pediatr Anesth 28:46–52

    Article  Google Scholar 

  3. Andersson H, Zarén B, Frykholm P (2015) Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite. Pediatr Anesth 25:770–777

    Article  Google Scholar 

  4. Beck CE, Rudolph D, Mahn C et al (2020) Impact of clear fluid fasting on pulmonary aspiration in children undergoing general anesthesia: Results of the German prospective multicenter observational (NiKs) study. Pediatr Anesth 30:892–899

    Article  Google Scholar 

  5. Bilku D, Dennison A, Hall T et al (2014) Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl 96:15–22

    Article  CAS  Google Scholar 

  6. Bonner JJ, Vajjah P, Abduljalil K et al (2015) Does age affect gastric emptying time? A model-based meta-analysis of data from premature neonates through to adults: Does gastric emptying change with age? Biopharm Drug Dispos 36:245–257

    Article  CAS  Google Scholar 

  7. Disma N, Thomas M, Afshari A et al (2019) Clear fluids fasting for elective paediatric anaesthesia: the European Society of Anaesthesiology consensus statement. Eur J Anaesthesiol 36:173–174

    Article  Google Scholar 

  8. Ellis RJ, Del Vecchio SJ, Kalma B et al (2018) Association between preoperative hydration status and acute kidney injury in patients managed surgically for kidney tumours. Int Urol Nephrol 50:1211–1217

    Article  Google Scholar 

  9. Falconer R, Skouras C, Carter T et al (2014) Preoperative fasting: current practice and areas for improvement. Updates Surg 66:31–39

    Article  CAS  Google Scholar 

  10. Fennelly M, Galletly D, Purdie GI (1991) Is caffeine withdrawal the mechanism of postoperative headache? Anesth Analg 72:449–453

    Article  CAS  Google Scholar 

  11. Friedrich S, Meybohm P, Kranke P (2020) Nulla Per Os (NPO) guidelines: time to revisit? Curr Opin Anaesthesiol 33:740–745

    Article  Google Scholar 

  12. Gemeinsame Stellungnahme (2016) Perioperative Antibiotikaprophylaxe, Präoperatives Nüchternheitsgebot, Präoperative Nikotinkarenz. Anästh Intensivmed 57:231–233

  13. Kaška M, Grosmanová T, Havel E et al (2010) The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery—a randomized controlled trial. Wien Klin Wochenschr 122:23–30

    Article  Google Scholar 

  14. Kluger MT, Short TG (1999) Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia 54:19–26

    Article  CAS  Google Scholar 

  15. Kwon S, Thompson R, Dellinger P et al (2013) Importance of perioperative glycemic control in general surgery: a report from the surgical care and outcomes assessment program. Ann Surg 257:8–14

    Article  Google Scholar 

  16. Leiper JB (2015) Fate of ingested fluids: factors affecting gastric emptying and intestinal absorption of beverages in humans. Nutr Rev 73:57–72

    Article  Google Scholar 

  17. Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292

    Article  Google Scholar 

  18. Mendelson CL (1946) The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 52:191–205

    Article  CAS  Google Scholar 

  19. Newton RJG, Stuart GM, Willdridge DJ, Thomas M (2017) Using quality improvement methods to reduce clear fluid fasting times in children on a preoperative ward. Pediatr Anesth 27:793–800

    Article  Google Scholar 

  20. Okabe T, Terashima H, Sakamoto A (2015) Determinants of liquid gastric emptying: comparisons between milk and isocalorically adjusted clear fluids. Br J Anaesth 114:77–82

    Article  CAS  Google Scholar 

  21. Radtke FM, Franck M, MacGuill M et al (2010) Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anaesthesiol 27:411–416

    Article  CAS  Google Scholar 

  22. Simon P, Pietsch U‑C, Oesemann R et al (2017) Präoperative Flüssigkeitskarenz in der bariatrischen Chirurgie. Anaesthesist 66:500–505

    Article  CAS  Google Scholar 

  23. Tamm ERKA (2012) Magen und Duodenum – Anatomie und Physiologie. In: Klin. Gastroenterol. Thieme, Stuttgart, S 212–219

    Google Scholar 

  24. Tan Z, Lee SY (2016) Pulmonary aspiration under GA: a 13-year audit in a tertiary pediatric unit. Pediatr Anesth 26:547–552

    Article  Google Scholar 

  25. Thomas M, Morrison C, Newton R, Schindler E (2018) Consensus statement on clear fluids fasting for elective pediatric general anesthesia. Pediatr Anesth 28:411–414

    Article  Google Scholar 

  26. Van de Putte P, Vernieuwe L, Jerjir A et al (2017) When fasted is not empty: a retrospective cohort study of gastric content in fasted surgical patients † †This Article is accompanied by Editorial Aew450. Br J Anaesth 118:363–371

    Article  Google Scholar 

  27. Warner MA, Warner ME, Weber JG (1993) Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology 78:56–62

    Article  CAS  Google Scholar 

  28. Weiß G, Jacob M (2008) Präoperative Nüchternheit 2008: Ärztliches Handeln zwischen Empirie und Wissenschaft. Anaesthesist 57:857–872

    Article  Google Scholar 

Download references

Danksagung

Wir danken Prof. Dr. Christian von Heymann für die kritische Durchsicht des Manuskriptes.

Author information

Authors and Affiliations

  1. Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Rudower Str. 48, 12351, Berlin, Deutschland

    Anne Rüggeberg & Herwig Gerlach

  2. Pflegedirektion, Vivantes Klinikum Neukölln, Berlin, Deutschland

    Peggy Dubois

  3. Klinik für Innere Medizin, Gastroenterologie, Diabetologie und Hepatologie, Vivantes Klinikum Neukölln, Rudower Straße 48, 12351, Berlin, Deutschland

    Ulrich Böcker

Authors
  1. Anne Rüggeberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peggy Dubois
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ulrich Böcker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Herwig Gerlach
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne Rüggeberg.

Ethics declarations

Interessenkonflikt

A. Rüggeberg, P. Dubois, U. Böcker und H. Gerlach geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rüggeberg, A., Dubois, P., Böcker, U. et al. Präoperative Flüssigkeitskarenz. Anaesthesist 70, 469–475 (2021). https://doi.org/10.1007/s00101-021-00918-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-021-00918-7

Schlüsselwörter

Keywords

Search

Navigation