Preoperative oral hydration in gynecologic laparoscopy

Having patients fast for at least 8 hours prior to surgery to decrease aspiration risk continues today in most institutions despite literature supporting the benefits of intake of clear liquids before surgery. National guidelines, in the United States and Europe, recommend an 8-hour fast from fatty foods but allow clear liquids up to 2 hours prior to surgery. This ingestion has been shown to have no effect on residual gastric volume, even in obese patients. Objective: The aim of this study was to evaluate the effect of preoperative oral hydration with a commercial, clear-liquid nutritional supplement, Nestlé's Breeze (Nestlé HealthCare Nutrition, Inc., Florham Park, NJ), on the gastric volume and pH of patients awaiting laparoscopic gynecologic surgery, compared to the same effects of standard preoperative fasting. Materials and Methods: For this pilot study, at a tertiary care hospital, 60 patients were studied. Thirty study patients ingested the product and ad libitum clear liquids before surgery and 30 control patients underwent standard preoperative fasting. All of the patients were instructed to take famotidine preoperatively, but some patients did not take this drug. After induction of anesthesia, gastric volume and pH were assessed in all patients. Results: Patients who had ingested the product had a mean gastric volume of 12.4amL with a pH of 3.5 when they received famotidine and 3 when they had not received famotidine, while patients who underwent standard preoperative fasting had a gastric volume of 23.1amL with a pH of 4.1 when they had received famotidine and 1.7 when they had not received famotidine. Conclusions: A clear-liquid nutritional supplement, ingested at least 2 hours prior to laparoscopic surgery, did not increase gastric volume or decrease pH, compared to conventional preoperative fasting and is an efficient way to provide nutrition and hydration to patients prior to laparoscopic surgery. (J GYNECOL SURG 31: 135)