Präoperative Nüchternheit – Risiken, Tücken, Wissenslücken

Die bronchopulmonale Aspiration ist eine seltene, jedoch potenziell lebensbedrohliche anästhesieassoziierte Komplikation. Um das Risiko zu reduzieren, ist die Beachtung strikter präoperativer Nüchternheitsintervalle seit Jahrzehnten ein fest etablierter Sicherheitsstandard. Da die präoperative Flüssigkeits- und Nahrungsrestriktion jedoch auch schaden kann, sollte die gegenwärtige Umsetzung der Nüchternheitsvorgaben, insbesondere bezüglich der präoperativen Flüssigkeitsrestriktion, kritisch hinterfragt werden.

• Literatur

• 1 Warner MA, Warner ME, Weber JG. Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology 1993; 78: 56-62
• 2 Olsson GL, Hallen B, Hambraeus-Jonzon K. Aspiration during anaesthesia: a computer-aided study of 185 358 anaesthetics. Acta Anaesthesiol Scand 1986; 30: 84-92
• 3 Cook TM, Woodall N, Frerk C. et al Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011; 106: 617-631
• 4 Engelhardt T, Webster NR. Pulmonary aspiration of gastric contents in anaesthesia. Br J Anaesth 1999; 83: 453-60
• 5 Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 1946; 52: 191-205
• 6 Huxley EJ, Viroslav J, Gray WR. et al Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1978; 64: 564-568
• 7 Asai T. Editorial II: Who is at increased risk of pulmonary aspiration?. Br J Anaesth 2004; 93: 497-500
• 8 Roberts RB, Shirley MA. Reducing the risk of acid aspiration during cesarean section. Anesth Analg 1974; 53: 859-68
• 9 Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration Anesthesiology 2017; 126: 376-393
• 10 Smith I, Kranke P, Murat I. et al Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2011; 28: 556-69
• 11 Gemeinsame Stellungnahme der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, der Deutschen Gesellschaft für Chirurgie, des Berufsverbandes Deutscher Anästhesisten und des Berufsverbandes der Deutschen Chirurgen. Perioperative Antibiotikaprophylaxe. Präoperatives Nüchternheitsgebot. Präoperative Nikotinkarenz Anästh Intensivmed 2016; 57: 231-3
• 12 Breuer JP, Bosse G, Seifert S. et al Pre-operative fasting: a nationwide survey of German anaesthesia departments. Acta Anaesthesiol Scand 2010; 54: 313-20
• 13 Breuer JP, Bosse G, Prochnow L. et al Verkürzte präoperative Nüchternheit. Erhebung eines Istzustands nach Analyse von Patienten- und Mitarbeiteraussagen. Anaesthesist 2010; 59: 607-13
• 14 Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev 2003
• 15 Hausel J, Nygren J, Lagerkranser M. et al A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg 2001; 93: 1344-50
• 16 Henriksen MG, Hessov I, Dela F. et al Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery. Acta Anaesthesiol Scand 2003; 47: 191-9
• 17 Bilku DK, Dennison AR, Hall TC. et al Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl 2014; 96: 15-22
• 18 Yuill KA, Richardson RA, Davidson HI. et al The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively--a randomised clinical trial. Clin Nutr 2005; 24: 32-7
• 19 Smith MD, McCall J, Plank L. et al Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev 2014
• 20 Nascimento AC, Goveia CS, Guimaraes GMN. et al Assessment of gastric emptying of maltodextrin, coffee with milk and orange juice during labour at term using point of care ultrasound: a non-inferiority randomised clinical trial. Anaesthesia 2019; 74: 856-61
• 21 Murray R, Eddy DE, Bartoli WP. et al Gastric emptying of water and isocaloric carbohydrate solutions consumed at rest. Med Sci Sports Exerc 1994; 26: 725-32
• 22 Rehrer NJ, Beckers EJ, Brouns F. et al Effects of electrolytes in carbohydrate beverages on gastric emptying and secretion. Med Sci Sports Exerc 1993; 25: 42-51
• 23 Popivanov P, Irwin R, Walsh M. et al Gastric emptying of carbohydrate drinks in term parturients before elective caesarean delivery: an observational study. Int J Obstet Anesth 2020; 41: 29-34
• 24 Brianez LR, Caporossi C, de Moura YW. et al Gastric residual volume by magnetic ressonance after intake of maltodextrin and glutamine: a randomized double-blind, crossover study. Arq Gastroenterol 2014; 51: 123-7
• 25 Horowitz M, O’Donovan D, Jones KL. et al Gastric emptying in diabetes: clinical significance and treatment. Diabet Med 2002; 19: 177-94
• 26 Gustafsson UO, Nygren J, Thorell A. et al Pre-operative carbohydrate loading may be used in type 2 diabetes patients. Acta Anaesthesiol Scand 2008; 52: 946-51
• 27 Schieren M, Wappler F. Kaffee, Kippe, Kaugummi – Mythen und Fakten zur präoperativen Nüchternheit. Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 142-5
• 28 Franke A, Nakchbandi IA, Schneider A. et al The effect of ethanol and alcoholic beverages on gastric emptying of solid meals in humans. Alcohol Alcohol 2005; 40: 187-93