Safety and efficacy of oral rehydration therapy until 2 h before surgery: a multicenter randomized controlled trial

Abstract

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.

The effect of enhanced recovery program for patients undergoing partial laparoscopic hepatectomy of liver cancer

“…A multicenter clinical study found that oral rehydration therapy until 2 h before surgery was 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 [35]. Continuous epidural analgesia is effective for the treatment of postoperative intestinal paralysis.…”

The Perioperative Effects of Preoperative Fasting Time on the Healthy Adults Undergoing Laparoscopic Cholecystectomy

“…Benzer bir çalışmada, düşük riskli hastalara ameliyattan 2 saat öncesinde oral rehidratasyon sıvısı verilmesinin hastaların preoperatif dönemde duyduğu açlık ve susuzluk hissini azaltan, güvenli bir yöntem olduğu gösterilmiştir. 12 Mide rezidüel volümünün 25 ml'nin üstünde ve pH değerinin de 2,5'in altında olduğu hastalar, anestezi indüksiyonu aşamasında pulmoner aspirasyon açısından riskli kabul edilmektedir. 7,8 Çalış-mamızda aç kalma süresinin artışıyla paralel olarak mide rezidüel volümünün arttığı gösterilmiştir.…”

“…15 Japonya'da 2003 yılında anestezi eğitimi verilen hastanelerde aç kalma süresi ortalamaları öğle-den önceki vakalarda 9 saat, öğleden sonraki vakalarda 6 saat olarak tespit edilmiştir. 12 Ülke-mizde halen birçok merkezde öğleden sonraki vakalara sabah öğünü verme alışkanlığı olmadığın-dan, aç kalma süreleri çok uzayabilmektedir. Bizim çalışmamızda öğleden sonraya kalan vakaların ortalama 15-16 saati bulan açlık ve susuzluk süreleri olduğu saptanmıştır.…”

The Effect of Intraoperative Use of High-Dose Remifentanil on Postoperative Insulin Resistance and Muscle Protein Catabolism: A Randomized Controlled Study

“…ORS contains 2.5% carbohydrate and 50 mmol·L -1 sodium ions. Preoperative body fluid management with ORS is known as preoperative oral rehydration therapy (ORT) and is widely practiced in Japan instead of infusion therapy 14,15. In our hospital, patients are asked to drink 1500 mL of ORS packaged in 500-mL plastic bottles (OS-1, Otsuka Pharmaceutical Factory, Inc., Tokushima, Japan) for preoperative fluid and electrolyte replacement.…”