Masui. The Japanese journal of anesthesiology
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Recently, European countries and US have issued the practice guidelines for preoperative fasting, and there is a trend of shortening the fating time before surgery. In Japan, some institutions have just started to use an oral rehydration therapy by oral rehydration solutions, which is effective in the treatment of mild to moderate dehydration, and in the preoperative water and electrolyte management. Besides shortening the fasting time, water and electrolytes can be adequately given to the patients by oral rehydration therapy Currently, this therapy is gaining a widespread attention, because it can improve patients' satisfaction for preoperative care and is also a safe and efficient medical treatment.
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In recent years, various perioperative patient management programs have been proposed as "Enhanced recovery after surgery program" in order to improve patient prognosis. These programs are an evidence-based approach which does not use novel drugs or novel therapeutic intervention, but uses conventional medical therapy and skill. ⋯ Specifically, early postoperative recovery will be carefully managed by evaluating clinical variables such as "postoperative pain, gut dysfunction, and immobility". These programs aim to keep the reduction of body functions as marginally as possible by minimizing surgical stress imposed on patients and then help shorten the recovery time after surgery.
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Preoperative oral hydration is an important component of "enhanced recovery after surgery" strategies. This was originally developed for patients undergoing colon surgery. The Obstetric Anesthesia Practice Guideline issued by American Society of Anesthesiologists states that intake of minimum amount of clear fluid 2 hours prior to surgery may be safe. ⋯ Moreover, some articles suggest that oral hydration may improve utero-placental perfusion. Therefore, we have to balance risks and benefits of oral hydration in parturients. Further investigations are needed among this specific subgroup of patients in order to establish the safe application of preoperative oral hydration.
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Oral rehydration therapy before surgery may be useful for elderly patients in perioperative management especially induction of general anesthesia, as they cannot preserve water in the body sufficiently. In elderly patients oral rehydration therapy is favorable to intravenous hydration as in younger patients. However, if swallowing is impaired or there are risks for aspiration, gastric emptying rate is decreased; gastroesophageal reflux disease is pointed out; cognitive function is disordered; or delirium has appeared, oral rehydration therapy should be carefully considered. It may be necessary to provide preoperative oral rehydration therapy to high risk elderly patients when they are hospitalized and they should be watched for taking oral rehydration solution soon by hospital nurses.
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Intraoperative hypothermia causes several unfavorable events such as surgical site infection and cardiovascular events. Therefore, during anesthesia, temperature is routinely regulated, mainly by using external heating devices. Recently, oral amino acid intake and intravenous amino acid or fructose infusion have been reported to prevent intraoperative hypothermia during general and regional anesthesia. ⋯ According to the protocol, anesthesiologists play an important role in both intraoperative and perioperative management. Management of optimal body temperature by preoperative fluid management alone may be difficult. To this end, preoperative fluid management and nutrient management strategies such as preoperative oral fluid intake and carbohydrate loading have the potential to contribute to the prevention of intraoperative hypothermia.