Skip to main content
SpringerLink
Log in

Präoperative Nahrungskarenz

Ein update

  • Allgemeinanästhesie
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

An Erratum to this article was published on 01 January 2004

Zusammenfassung

Die Anordnung einer strikten Nahrungskarenz nach Mitternacht vor operativen Eingriffen in Narkose ist die geläufige Praxis in chirurgischen Einrichtungen in Deutschland. Das damit verfolgte Ziel ist eine Reduktion des perioperativen Aspirationsrisikos. Seit mehreren Jahren wird die wissenschaftliche Grundlage dieser Verfahrensweise zunehmend kritisch diskutiert. Insbesondere für die präoperative Einnahme von Wasser und klarer Flüssigkeit zeigen experimentelle wie klinische Untersuchungen, dass von einer vollständigen Magenpassage innerhalb von 2 h sicher ausgegangen werden kann und das Risiko nach begrenztem Trinken bis 2 h vor elektiven Operationen in Allgemeinanästhesie nicht erhöht ist. Zudem sind perioperative Aspirationszwischenfälle sehr selten, haben eine gute Prognose und sind eher auf Faktoren wie mangelnde Narkosetiefe oder unzureichende Atemwegsprotektion zurückzuführen als auf den Nüchternheitsstatus des Patienten. Folglich haben zahlreiche nationale anästhesiologische Gesellschaften im Sinne eines verbesserten perioperativen Wohlbefindens der Patienten ihre offiziellen Leitlinien zur präoperativen Nüchternheit geändert und empfehlen unter Berücksichtigung definierter Einschränkungen und Kontraindikationen einen gelockerten Umgang mit der Einnahme flüssiger wie fester Nahrung vor elektiven Eingriffen. Die vorliegende Arbeit gibt eine zusammenfassende Übersicht über die Hintergründe, auf denen diese national erstellten Leitlinien beruhen, mit der Absicht auch für Deutschland eine Empfehlung zur Lockerung der präoperativen Nüchternheit für klare Flüssigkeiten vorzuschlagen.

Abstract

In Germany the predominant standard of preoperative care for elective surgery is fasting after midnight, with the aim of reducing the risk of pulmonary aspiration. However, for the past several years the scientific evidence supporting such a practice has been challenged. Experimental and clinical studies prove a reliable gastric emptying within 2 h suggesting that, particularly for limited intake of clear fluids up to 2 h preoperatively, there would be no increased risk for the patient. In addition, the general incidence of pulmonary aspiration during general anaesthesia (before induction, during surgery and during recovery) is extremely low, has a good prognosis and is more a consequence of insufficient airway protection and/or inadequate anaesthetic depth rather than due to the patient's fasting state. Therefore, primarily to decrease perioperative discomfort for patients, several national anaesthesia societies have changed their guidelines for preoperative fasting. They recommend a more liberal policy regarding per os intake of both liquid and solid food, with consideration of certain conditions and contraindications. The following article reviews the literature and gives an overview of the scientific background on which the national guidelines are based. The intention of this review is to propose recommendations for preoperative fasting regarding clear fluids for Germany as well.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Agarwal A, Chari P, Singh H (1989) Fluid deprivation before operation. The effect of a small drink. Anaesthesia 44:632–634

    CAS  PubMed  Google Scholar 

  2. American Society of Anesthesiologists Task Force on Preoperative Fasting (1999) 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. Anesthesiology 90:896–905

    PubMed  Google Scholar 

  3. Bannister WK (1962) Vomiting and aspiration during anaesthesia. Anesthesiology 23:251–264

    CAS  Google Scholar 

  4. Brock-Utne JG (1996) Clear fluids, not breakfast, before surgery. Acta Anaesthesiol Scand 40:507–508

    CAS  PubMed  Google Scholar 

  5. Brock-Utne JG, Moshal MG, Downing JW, Spitaels JM, Stiebel R (1977) Fasting volume and acidity of stomach contents associated with gastrointestinal symptoms. Anaesthesia 32:749–752

    CAS  PubMed  Google Scholar 

  6. Burkhart DM (1999) Management of acute gastroenteritis in children. Am Fam Physician 60:2555–2565

    CAS  PubMed  Google Scholar 

  7. Canadian Anaesthesiologists' Society Toronto (2002) Guidelines to the practice of anaesthesia. Canadian Anaesthesiologists' Society.http://www.cas.ca/guidelines/practice.asp. Cited September 2003

  8. Crawford M, Lerman J, Christensen S et al. (1990) Effects of duration of fasting on gastric fluid pH and volume in healthy children. Anesth Analg 71:400–403

    CAS  Google Scholar 

  9. Edwards G, Morton HJV, Pask EA, Wylie WD (1956) Deaths associated with anaesthesia. A report on 1000 cases. Anaesthesia 11:194–220

    Google Scholar 

  10. Eriksson LI, Sandin R (1996) Fasting guidelines in different countries. Acta Anaesthesiol Scand 40:971–974

    CAS  PubMed  Google Scholar 

  11. Fasting S, Soreide E, Raeder JC (1998) Changing preoperative fasting policies. Impact of a national consensus. Acta Anaesthesiol Scand 42:1188–1191

    CAS  PubMed  Google Scholar 

  12. Fennelly M, Galletly DC, Purdie GI (1991) Is caffeine withdrawal the mechanism of postoperative headache? Anesth Analg 72:449–453

    CAS  PubMed  Google Scholar 

  13. Gibbs CP, Modell JH (1986) Aspiration pneumonitis. Anaesthesia 3:2023–2050

    Google Scholar 

  14. Gust R (2001) Präoperative Nüchternheit. Anaesthesist 9:717–718

  15. Haas U, Motsch J, Schreckenberger R, Bardenheuer HJ, Martin E (1998) Prämedikation und präoperative Nahrungskarenz in der Kinderanästhesie. Anaesthesist 47:838–843

    Article  CAS  PubMed  Google Scholar 

  16. Haavik P, Soreide E, Hofstad P, Stehen PA (1992) Does preoperative anxiety influence gastric fluid volume and acidity? Anesth Analg 75:91–94

    CAS  PubMed  Google Scholar 

  17. Hausel J, Nygren J, Lagerkranser M et al. (2001) A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg 93:1344–1350

    CAS  PubMed  Google Scholar 

  18. Hutchinson A, Maltby J, Reid CRG (1988) Gastric fluid volume and pH in elective inpatients. Part I: coffee or orange juice versus overnight fast. Can J Anaesth 35:12–15

    CAS  PubMed  Google Scholar 

  19. Hutson WR, Roehrkasse RL, Wald A (1989) Influence of gender and menopause on gastric emptying and motility. Gastroenterology 96:11–17

    CAS  PubMed  Google Scholar 

  20. Hveem K, Hausken T, Berstad A (1994) Ultrasonographic assessment of fasting liquid content in the human stomach. Scand J Gastroenterol 29:786–789

    CAS  PubMed  Google Scholar 

  21. Kallar SK, Everett LL (2003) Potential risks and preventive measures for pulmonary aspiration: new concepts in preoperative fasting guidelines. Anesth Analg 77:171–182

    Google Scholar 

  22. Kluger MT, Short TG (1999) Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia 54:19–26

    Article  CAS  PubMed  Google Scholar 

  23. Ljungqvist O, Soreide E (2003) Preoperative fasting. Br J Surg 90:400–406

    Article  CAS  PubMed  Google Scholar 

  24. Ljungqvist O, Nygren J, Thorell A (2002) Cinical nutrition and metabolism symposium on "endocrine and nutritional modulation of the metabolic response to stress". Modulation of post-operative insuline resistance by pre-operative carbohydrate loading. Proc Nutr Soc 61:329–335

    Article  CAS  PubMed  Google Scholar 

  25. Lydon A, McGinley J, Cooke T, Duggan PF, Shorten GD (1998) Effect of anxiety on the rate of gastric emptying of liquids. Br J Anaesth 81:522–525

    CAS  PubMed  Google Scholar 

  26. Maltby JR, Sutherland AD, Sale JP, Shaffer EA (1986) Preoperative oral fluids: is a five-hour fast justified prior to elective surgery? Anesth Analg 65:1112–1116

    CAS  PubMed  Google Scholar 

  27. Maltby J, Koehli N, Ewen A, Shaffer EA (1988) Gastric fluid volume, pH, and gastric emptying in elective inpatients. Influences of narcotic-atropine premedication, oral fluid, and ranitidine. Can Anaesth Soc J 35:562–566

    CAS  Google Scholar 

  28. Maltby JR, Lewis P, Martin A, Sutheriand LR (1991) Gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery. Can J Anaesth 38:425–429

    CAS  PubMed  Google Scholar 

  29. Mangler C, Kastrup M, Spies C (2003) Anordnung von Medikamenten zur Prämedikation; Flüssigkeits- und Nahrungskarenz, perioperative Stressprophylaxe bei Nebenierenrindensuppression. In: Kox WJ, Spies D (Hrsg) Check-up Anästhesiologie. Springer, Berlin Heidelberg New York, S 5–6

  30. Marshall BM, Gordon RA (1958) Vomiting, regurgitation and aspiration in anaesthesia. Can Anaesth Soc J 5:439–447

    Google Scholar 

  31. Mendelson CL (1946) The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 52:191–205

    Google Scholar 

  32. Miller M, Wishart HY, Nimmo WS (1983) Gastric contents at induction of anaesthesia. Is a 4-hour fast necessary? Br J Anaesth 55:1185–1188

    CAS  PubMed  Google Scholar 

  33. Minami H, McCallum RW (1984) The physiology and pathophysiology of gastric emptying in humans. Gastroenterology 86:1592–1610

    CAS  PubMed  Google Scholar 

  34. Murphy GS, Ault ML, Wong HY, Szokol JW (2000) The effect of a new NPO policy on operating room utilizations. J Clin Anesth 12:48–51

    Article  CAS  PubMed  Google Scholar 

  35. Nygren J, Thorell A, Jacobsson H, Larsson S, Schnell PO, Hylen L, Ljungqvist O (1995) Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg 222:728–734

    CAS  PubMed  Google Scholar 

  36. Nygren J, Soop M, Thorell A, Efendic S, Nair KS, Ljungqvist O (1998) Preoperative oral carbohydrate administration reduces postoperative insuline resistance. Clin Nutr 17:65–71

    CAS  PubMed  Google Scholar 

  37. O'Mullane EJ (1954) Vomiting and regurgitation during anaesthesia. Can Anaesth Soc J 33:345–348

    Google Scholar 

  38. Olsson GL, Hallen B, Hambraeus-Jonzon K (1986) Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. Acta Anaesthesiol Scand 30:84–92

    CAS  PubMed  Google Scholar 

  39. Pearse SK, Rajakulendran Y (1999) Preoperative fasting and administration of regular medication adult patients presenting for elective surgery. Has the new evidence changed practice? Eur J Anaesthesiol 16:565–568

    Article  CAS  PubMed  Google Scholar 

  40. Pedersen T, Johansen SH (1989) Serious morbidity attributable to anaesthesia. Considerations for prevention. Anaesthesia 44:504–508

    CAS  PubMed  Google Scholar 

  41. Petring OU, Blake DW (1993) Gastric emptying in adults: an overview related to anaesthesia. Anaesth Intensive Care 21:774–781

    CAS  PubMed  Google Scholar 

  42. Phillips S, Hutchinson S, Davidson T (1993) Preoperative drinking does not affect gastric contents. Br J Anaesth 70:6–9

    CAS  PubMed  Google Scholar 

  43. Plourde G, Hardy JF (1986) Aspiration pneumonia: assessing the risk of regurgitation in the cat. Can Anaesth Soc J 33:345–348

    CAS  PubMed  Google Scholar 

  44. Ramirez-Mora JC, Moyao-Garcia D, Nava-Ocampo AA (2002) Attitudes of Mexican anesthesiologists to indicate preoperative fasting periods: a cross-sectional survey. BMC Anesthesiology 2:1–6

    Article  PubMed  Google Scholar 

  45. Read MS, Vaughan RS (1999) Allowing pre-operative patients to drink: effects on patients' safety and comfort of unlimited oral water until 2 hours before anaesthesia. Acta Anaesthesiol Scand 35:591–595

    Google Scholar 

  46. Scarr M, Maltby J, Kani K, Sutherland A (1989) Volume and acidity of residual gastric fluid after oral fluid ingestion before elective ambulatory surgery. Can Med Assoc J 141:1151–1154

    CAS  Google Scholar 

  47. Scott AM, Kellow JEK, Shuter B, Nolan JM, Hoschl R, Jones MP (1993) Effects of cigarette smoking on solid and liquid intragastric distribution and gastric emptying. Gastroenterology 104:410–416

    CAS  PubMed  Google Scholar 

  48. Sethi AK, Chatterji C, Bhargava SK, Narang P, Tyagi A (1999) Safe pre-operative fasting times after milk or clear fluid in children. Anaesthesia 54:51–85

    Article  CAS  PubMed  Google Scholar 

  49. Shevde K, Trivedi N (1991) Effects of clear liquids on gastric volume and pH in healthy volunteers. Anaesth Analg 72:528–531

    CAS  Google Scholar 

  50. Simini B (1999) Preoperative fasting. Lancet 353:862

    Article  CAS  PubMed  Google Scholar 

  51. Simpson JY (1848) The alleged case of death from the action of chloroform. Lancet I:175–176

    Google Scholar 

  52. Smith A (2000) Preoperative fasting in adults. In: Lack JA, White LA, Thomas GM, Rollin A-M (eds) Raising the standard. Royal College of Anaesthesists, London

  53. Soop M, Nygren J, Myrenfors P, Thorell A, Ljungqvist O (2001) Preoperative oral carbohydrate treatment attenuates immediate postoperative insuline resistance. Am J Physiol Endocrinol Metab 280:E576–583

    CAS  PubMed  Google Scholar 

  54. Soreide E, Holst-Larsen H, Reite K, Mikkelsen H, Soreide JA, Stehen PA (1993) Effects of giving water 20–450 ml with oral diazepame premedication 1–2 h before operation. Br J Anaesth 71:503–506

    CAS  PubMed  Google Scholar 

  55. Soreide E, Stromskag KE, Stehen PA (1995) Statistical aspects in studies of preoperative fluid intake and gastric content. Acta Anaesthesiol Scand 39:738–743

    CAS  PubMed  Google Scholar 

  56. Soreide E, Hausken T, Soreide JA, Stehen PA (1996) Gastric emptying of a light hospital breakfast. A study using real time ultrasonography. Acta Anaesthesiol Scand 40:549–553

    CAS  PubMed  Google Scholar 

  57. Soreide E, Fasting S, Raeder JC (1997) New preoperative fasting guidelines in Norway. Acta Anaesthesiol Scand 41:799

    CAS  PubMed  Google Scholar 

  58. Strunin L (1993) How long should patients fast before surgery? Time for new guidelines. Br J Anaesth 70:1–3

    CAS  Google Scholar 

  59. Sutherland AD, Stock JG, Davies M (1986) Effects of preoperative fasting on morbidity and gastric contents in patients undergoing day-stay surgery. Br J Anaesth 58:876–878

    CAS  PubMed  Google Scholar 

  60. Sutherland AD, Maltby JR, Sale JP, Reid CRG (1987) The effect of preoperative oral fluid and ranitidine on gastric fluid volume and pH. Can J Anaesth 34:117–121

    CAS  PubMed  Google Scholar 

  61. Tryba M, Zenz M, Mlasowsky B, Huchzermeyer H (1983) Does a stomach tube enhance regurgitation during general anaesthesia? Anaesthesist 32:407–409

    CAS  PubMed  Google Scholar 

  62. Wahlen BM, Michalsen A (2001) Anästhesie im praxis-ambulanten Bereich. Anaesthesiol Reanim 26:144–153

    CAS  PubMed  Google Scholar 

  63. Warner MA, Warner ME, Weber JG (1993) Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology 78:56–62

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie und operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Gemeinsame Einrichtung von Freier Universität Berlin und Humboldt-Universität zu Berlin

    C. D. Spies, J. P. Breuer & W. J. Kox

  2. Universitätsklinik für Anästhesiologie, Heidelberg

    R. Gust & E. Martin

  3. Chirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München

    M. Wichmann

  4. Klinik für Anästhesie, operative Intensivmedizin und Rettungsmedizin, Klinikum der Stadt Wolfsburg

    M. Adolph

  5. Chirurgische Klinik, Marienhospital Witten, Lehrkrankenhaus der Ruhr-Universität Bochum

    M. Senkal

  6. Klinik für Anästhesiologie und Intensivmedizin, Ev. Krankenhaus Hattingen, Lehrkrankenhaus der Ruhr-Universität Bochum

    U. Kampa

  7. Ministerialdirigent i.R., Medizinrecht, Nürnberg

    W. Weissauer

  8. Institut für Anästhesie und operative Intensivmedizin, Universitätsklinikum Mannheim und BDA-Referat für Krankenhausmanagement und -ökonomie

    A. Schleppers

  9. Department of Anesthesia and Intensive Care Medicine, Rogaland Central and University Hospital, Stavanger, Norwegen

    E. Soreide

  10. Klinik für Anästhesiologie und operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Gemeinsame Einrichtung von Freier Universität Berlin und Humboldt-Universität zu Berlin

    U. Kaisers & K. J. Falke

  11. Klinik für Unfall- und Wiederherstellungschirurgie, Charité-Universitätsmedizin Berlin, Gemeinsame Einrichtung von Freier Universität Berlin und Humboldt-Universität zu Berlin

    N. Haas

  12. Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Charité Campus Mitte, Schumannstr. 21/22, 10117 , Berlin

    C. D. Spies

Authors
  1. C. D. Spies
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. P. Breuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Gust
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Wichmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Adolph
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Senkal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. U. Kampa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. W. Weissauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Schleppers
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. E. Soreide
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. E. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. U. Kaisers
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. K. J. Falke
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. N. Haas
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. W. J. Kox
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. D. Spies.

Additional information

Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/s00101-003-0642-4 zu finden.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Spies, C.D., Breuer, J.P., Gust, R. et al. Präoperative Nahrungskarenz. Anaesthesist 52, 1039–1045 (2003). https://doi.org/10.1007/s00101-003-0573-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-003-0573-0

Schlüsselwörter

Keywords

Search

Navigation