Benefits of Reducing Pre Surgery Fasting

ClearFast applauds Doctor De Jonghe and his co-investigators on their recently published manuscript entitled “Reducing pre-operative fasting while preserving operating room scheduling flexibility: feasibility and impact on patient discomfort”, Acta Anaesthesiologica Scandinavica 2016. This study is a novel effort to reconcile some of the now well-recognized benefits of pre-operative oral carbohydrate loading (with ample complex carbohydrates) with the practical flexibility needs of busy ORs around the world. While the authors fully recognized some of the shortcomings of their study, including a lack of randomization and various “organizational constraints”, their message was clear: the need to reduce the duration of the traditional pre-op liquid fast with appropriate true carbohydrate-rich beverages is no longer debatable… it is a mandate!

Of note, in the “CHO Group”, the percentage of patients actually receiving the drink preceding operations scheduled at 10:00 or later was similar for inpatients and outpatients. However, that was clearly not the case for surgeries scheduled before 10 am. Patients were deprived of the drink 100% of the time if they were admitted on the day of surgery for procedures scheduled at that time or earlier. Conversely, 89.5% of their in-house counterparts were “carb-loaded” for operations scheduled for the same time. The explanation for this discrepancy appears procedural and systematic: possibly for standardization purposes, the drink was re-constituted from a powder, not by the patients, but by respective hospital staff members who diluted one sachet “in 400 ml of water in a graduated shaker.” Unfortunately, “organizational constraints” apparently prohibited such mixing and delivering to those arriving so early on the day of surgery. This bias dramatically impacted that statistic.

Perhaps, the overall outcomes might have been significantly influenced by the use of a pre-mixed carb-rich beverage, such as ClearFast®. Some of the obvious advantages would include simplicity of the delivery system, reliable standardization of the product volume and mixture and expedited refrigeration, if desired.   It would allow for early and convenient distribution to patients – days to weeks prior to the date of surgery, thus facilitating consumption by a greater number of candidates, potentially resulting in fasting times closer to the proposed 3-hour window. As the authors suggest in their discussion, “The opportunity for these patients to consume the CHO drink before arriving to the hospital warrants further consideration.”

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