PurposeIn many countries, patients are generally allowed to have clear fluids until 2–3 h before surgery. In Japan, long preoperative fasting is still common practice. To shorten the preoperative fasting period in Japan, we tested the safety and efficacy of oral rehydration therapy until 2 h before surgery.MethodsThree hundred low-risk patients scheduled for morning surgery in six university-affiliated hospitals were randomly assigned to an oral rehydration solution (ORS) group or to a fasting group. Patients in the ORS group consumed up to 1,000 ml of ORS containing balanced glucose and electrolytes: 500 ml between 2100 the night before surgery and the time they woke up the next morning and 500 ml during the morning of surgery until 2 h before surgery. Patients in the fasting group started fasting at 2100 the night before surgery. Primary endpoints were gastric fluid volume and pH immediately after anesthesia induction. Several physiological measures of hydration and electrolytes including the fractional excretion of sodium (FENa) and the fractional excretion of urea nitrogen (FEUN) were also evaluated.ResultsMean (SD) gastric fluid volume immediately after anesthesia induction was 15.1 (14.0) ml in the ORS group and 17.5 (23.2) ml in the fasting group (P = 0.30). The mean difference between the ORS group and fasting group was −2.5 ml. The 95% confidence interval ranged from −7.1 to +2.2 ml and did not include the noninferior limit of +8 ml. Mean (SD) gastric fluid pH was 2.1 (1.9) in the ORS group and 2.2 (2.0) in the fasting group (P = 0.59). In the ORS group, mean FENa and FEUN immediately after anesthesia induction were both significantly greater than those in the fasting group (P < 0.001 for both variables). The ORS group reported they had been less thirsty and hungry before surgery (P < 0.001, 0.01).ConclusionsOral rehydration therapy until 2 h before surgery is safe and feasible in the low-risk Japanese surgical population. Physicians are encouraged to use this practice to maintain the amount of water in the body and electrolytes and to improve the patient’s comfort.

hospital due to increase of repeated episodes for the previous 1 month and was scheduled for surgical repair of the TOF. These attacks continued after admission, and his last attack occurred 1 week before operation. Clinical examination showed erythrocytosis (hemoglobin concentration, 17.5 g·dl Ϫ1 ; hematocrit, 51.6%), slight coagulopathy (thrombo test, 72%), and slight hypofibrinogenemia (fibrinogen, 187 mg·dl Ϫ1 ). Electrocardiography showed subendocardial ischemia and right ventricular hypertrophy. Angiography revealed severe infundibular stenosis and mild valvular stenosis without coronary disease. Preoperative catheterization measurements were as follows: right ventricular pressure similar to left ventricular pressure, mean pulmonary artery pressure 30 mmHg, left to right shunt ratio 59%, Qp/Qs 2.3, aortic O 2 saturation 88%. Chest X-ray showed right aortic arch and no increase in density in the entire lung field.The patient received routine premedication with 0.4 mg scopolamine hydrobromide and 50 mg pethidine intramuscularly 30 min prior to induction of anesthesia. He was sedated and hemodynamically stable; blood pressure (BP) was 120/70 mmHg. Appropriate monitors were attached, and a left radial artery cannula was inserted for continuous BP monitoring. General anesthesia was induced with 0.5 mg fentanyl and 0.1 mg·kg Ϫ1 midazolam intravenously. Intubation was performed after giving 0.2 mg·kg Ϫ1 vecuronium intravenously with no remarkable change in vital signs or ECG. Anesthesia was maintained with 50% nitrous oxide in 50% oxygen and 40 µg·kg Ϫ1 fentanyl as required until sternotomy was performed. A pulmonary catheter was inserted via the right internal jugular vein, and the following initial mean pressures were obtained: right ventricle, 90 mmHg; pulmonary artery, 15 mmHg; pulmonary capillary wedge, 9 mmHg; and central venous pressure, 17 mmHg. SEP (somatosensory evoked potential) was monitored continuously to evaluate cerebral oxygenation and blood perfusion. Arterial BP and heart rate

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