Effects of oral rehydration therapy on gastric volume and pH in patients with preanesthetic H2 antagonist

2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting

These practice guidelines are a modular update of the "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures." The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.

Benefits of Enhanced Recovery After Surgery in Patients Undergoing Endoscopic Sinus Surgery

Background

Although enhanced recovery after surgery (ERAS) protocols have been widely applied during perioperative periods for different diseases, there are few reports of ERAS in patients undergoing endoscopic sinus surgery (ESS). This study therefore aimed to evaluate the benefits of ERAS protocol compared to traditional care following ESS.

Methods

A total of 55 patients with chronic rhinosinusitis undergoing ESS were prospectively assigned to 1 of 5 treatment groups; ERAS groups with postoperative intravenous Flubiprofen Axetil or analgesia pump, traditional care with Flubiprofen Axetil or analgesia pump (NERAS groups), or traditional care without postoperative intravenous analgesia group (control). All patients completed the Kolcaba General Comfort Questionnaire, Medical Outcomes Study Sleep Scale, and Self-rating Anxiety Scale at admission and before discharge. Pain scores were recorded at 2, 6, 24, and 48 hours postsurgery and adverse reactions to analgesics were noted.

Results

Patients in ERAS group demonstrated significantly higher general comfort scores and lower self-rating anxiety scores compared to patients in NERAS and control groups. Compared to control patients, patients in ERAS group reported significantly lower pain scores at 6, 24, and 48 hours. Moreover, pain alleviated from 6 hours postsurgery in ERAS group compared to 48 hours in NERAS group. Patients using opioids experienced more adverse nausea events than patients using only nonsteroidal anti-inflammatory drugs (NSAIDs).

Conclusions

The use of patient-tailored ERAS programs following ESS may help to attain higher general comfort and to alleviate perioperative anxiety compared with traditional perioperative care. Adequate postoperative analgesia with NSAIDs in ERAS protocol may alleviate pain earlier with fewer adverse reactions.

The effect of oral hydration on the risk or aspiration and hemodynamic stability before the induction of anesthesia: A systematic review and meta-analysis

OBJECTIVE

Preoperative oral rehydration solutions (ORS) are frequently used in clinical practice in Japan, although their effect remains to be explained. The purpose of this study was to investigate the clinical outcomes associated with ORS usage.

DESIGN

Systematic review and meta-analysis.

SETTING

Surgical departments at each hospital.

PARTICIPANTS

A total of 546 patients with American Society of Anesthesiologists physical status classification I or II (non-pregnant adults only) reported in six articles.

INTERVENTIONS

Patients in the included studies had originally been randomly allocated to the ORS or control group.

MEASUREMENTS

Incidence of aspiration and vomiting during induction of anesthesia, gastric fluid volume (absolute volume), gastric pH, stroke volume variation (SVV) during induction of anesthesia. Risk difference (RD) or mean difference (MD) with 95% confidence interval (CI) were calculated using a random effects model.

MAIN RESULTS

There was no aspiration or vomiting in either group [3 studies, 428 patients, RD 0 (95% CI -0.01 to 0.01), I² = 0%]. ORS administration caused no significant difference in gastric volume [4 studies, 486 participants, MD -1.12 ml (95% CI -5.61 to 3.36), I² = 62%] or gastric pH [4 studies, 486 participants, MD -0.03. (95% CI -0.37 to 0.31), I² = 0%] compared with the control group. In contrast, ORS resulted in a significant reduction in SVV during the anesthesia induction period [3 studies, 118 participants, MD -3.02 (95% CI -5.44 to -0.59), I² = 65%].

CONCLUSIONS

Our systematic review indicates that oral rehydration therapy does not increase the risk of aspiration or vomiting. In contrast, it may help stabilize circulatory dynamics during anesthesia induction.

Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures

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