ABSTRACT
Desde 1990 las sociedades de Anestesiología han realizado distintas guías de ayuno preoperatorio ya no solo para disminuir la incidencia de aspiración pulmonar y morbilidad anestésica, sino para aumentar el bienestar del paciente previo a la anestesia. Algunas de estas sociedades han ido actualizando sus guías, de manera que desde 2010 ya disponemos de 2 dedicadas al ayuno preoperatorio basadas en la evidencia. Con este trabajo se ha pretendido revisar las actualizaciones de las guías, así como las pautas actuales para pacientes más controvertidos, como lactantes, obesos y programados para cierto tipo de cirugía oftálmica (AU)
Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery (AU)
Subject(s)
Humans , Fasting , Food Deprivation , Respiratory Aspiration/prevention & control , Anesthesia/methods , Intraoperative Complications/prevention & control , Preoperative Care/methods , Practice Patterns, Physicians' , Obesity/complications , Gastric EmptyingABSTRACT
Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery.
Subject(s)
Fasting , Practice Guidelines as Topic , Preoperative Care/standards , Adult , Child , HumansSubject(s)
Fluid Therapy/methods , Perioperative Care/methods , Child , Child, Preschool , Contraindications , Fluid Therapy/adverse effects , Glucose/administration & dosage , Glucose/pharmacokinetics , Humans , Hyponatremia/chemically induced , Hyponatremia/prevention & control , Hyponatremia/therapy , Hypotonic Solutions , Infant , Intraoperative Complications/chemically induced , Intraoperative Complications/prevention & control , Intraoperative Complications/therapy , Isotonic Solutions/administration & dosage , Isotonic Solutions/pharmacokinetics , Pediatrics , Perioperative Care/standards , Postoperative Complications/chemically induced , Postoperative Complications/prevention & control , Postoperative Complications/therapyABSTRACT
No disponible
Subject(s)
Child , Female , Humans , Male , Fluid Therapy/methods , Fluid Therapy/standards , Fluid Therapy , Intraoperative Period , Glucose/therapeutic use , Anesthesia , Fluid Therapy/instrumentation , Fluid Therapy/trends , Algorithms , /methods , Postoperative Period , Osmolar Concentration , Thoracic Surgery/methodsABSTRACT
Our greater understanding of gastric physiology and the epidemiology of Mendelson's syndrome has allowed the traditional guidelines for preoperative fasting (nothing by mouth after midnight or 6 hours before surgery) to be changed, based on the results of many scientific studies. The stomach is not emptied of liquids and solids in the same way, and therefore preoperative fasting should not be the same for both. Human milk leaves the stomach more rapidly than infant formulas, and the emptying of non-human milk is similar to that of solids. Fasting does not guarantee that the stomach will be empty or that the pH of gastric juices will be high; moreover, shortening the preoperative fasting period may bring several advantages for the patient. Factors such as premedication, anxiety, age, certain associated diseases or injuries may or may not influence gastric emptying and/or acidity at the time of anesthesia. We review the literature, including the guidelines on fasting of the American Society of Anesthesiologists for application with healthy patients of all ages in elective procedures, excluding, among others, women in childbirth and patients undergoing emergency surgery.
Subject(s)
Fasting , Pneumonia, Aspiration/prevention & control , Postoperative Complications/prevention & control , Preanesthetic Medication , Preoperative Care , Adult , Age Factors , Anesthesiology , Animals , Anxiety/physiopathology , Child , Child, Preschool , Elective Surgical Procedures , Emergencies , Female , Gastric Acid/metabolism , Gastric Emptying , Humans , Incidence , Infant , Pneumonia, Aspiration/epidemiology , Postoperative Complications/epidemiology , Practice Guidelines as Topic , Pregnancy , Sex Characteristics , Societies, Medical , Time Factors , United StatesABSTRACT
Gracias a un mejor conocimiento de la fisiología gástrica y de la epidemiología del síndrome de Mendelson y a la experiencia de múltiples trabajos científicos, ha sido posible modificar las pautas tradicionales de ayuno preoperatorio de nada por boca a partir de medianoche o de 6 horas antes de la intervención. Los líquidos y los sólidos no son vaciados igualmente del estómago, luego el ayuno preoperatorio no debería ser el mismo para ambos. La leche materna abandona el estómago más rápidamente que las fórmulas para lactantes, y la leche no humana es similar a los sólidos en cuanto al tiempo de vaciamiento gástrico. Ayunar no garantiza que el estómago estará vacío o que el pH del líquido gástrico será alto, y acortar el tiempo de ayuno preoperatorio puede aportar múltiples ventajas al paciente. Factores como la premedicación, la ansiedad, la edad, algunas patologías asociadas o los traumatismos, pueden o no influir sobre el vaciamiento y/o acidez gástrica en el momento de la anestesia. Presentamos una revisión de la literatura sobre el tema, que incluye la guía de la ASA de ayuno preoperatorio y uso de agentes farmacológicos para reducir el riesgo de aspiración pulmonar, para aplicar a pacientes sanos de todas la edades y procedimientos electivos, excluyendo, entre otros, mujeres de parto y cirugía de urgencia (AU)
