Are there any benefits from minimizing fasting and optimization of nutrition and fluid management for patients undergoing day surgery?
OBJECTIVE
As a result of advances in anaesthesia and surgery, an increasing number of surgical procedures are currently possible in the ambulatory setting. Nausea/vomiting and sedation/drowsiness are often associated with delayed discharge and readmission. These symptoms are also related to pharmacological treatment as well as dehydration and fasting. The evidence that preoperative fasting and dehydration not only reduces preoperative well being, but may also affect postoperative recovery is currently being reviewed.


RESULTS
In association with minor surgical procedures, rehydration with approximately 1 l fluid, and in cases with a moderate degree of surgery, such as laparoscopic surgery, 1-3 l fluid, given perioperatively will improve postoperative well being and recovery. Administration of a carbohydrate-rich beverage not only provides fluid but also counteracts the negative effects of preoperative fasting, which in turn reduces preoperative hunger and improves well being. Postoperatively, this treatment reduces insulin resistance, which may be relevant in surgery with significant postoperative stress response. Two studies on laparoscopic cholecystectomy demonstrate different results regarding effects on postoperative outcome and nausea/vomiting and further evaluation is required.


CONCLUSIONS
When preoperative dehydration is corrected, postoperative well being and clinical outcome improves. Avoiding preoperative fasting by administration of carbohydrate-rich beverages improves preoperative well being while effects on postoperative recovery in patients undergoing ambulatory surgery need to be further evaluated.
Nygren
Jonas
J
Centre of GastroIntestinal Disease, Ersta Hospital, and Karolinska Institutet and CLINTEC, Karolinska University Hospital Huddinge, Stockholm, Sweden. jonas.nygren@erstadiakoni.se
Thorell
Anders
A
Ljungqvist
Olle
O
D000556:Ambulatory Surgical Procedures; D003681:Dehydration / Q000628:therapy*; D005215:Fasting / Q000502:physiology*; D005440:Fluid Therapy; D006801:Humans; D015596:Nutrition Assessment; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care