On June 10, Nutripharma, a Prodiet brand in Poland, participated in the Polspen 2021 – XXIII Congress of the Polish Society of Parenteral, Enteral, and Metabolism. In the event, we broadcast a class with the doctor of Gastroenterology José Eduardo de Aguilar Nascimento, with the theme “Reduction of the Preoperative Fasting Period.” Check, firsthand, the essential information of the class.
The program is so relevant in medicine that for 15 years, it has been studying and presenting strategies for patients to have more health, comfort, and benefits after elective surgeries when performing preoperative fasting reduction. In 2005, the ACERTO project (Acceleration of Postoperative Total Recovery) was established, which focuses on multimodal perioperative care. The project topics carry out several interventions; among them are the nutritional ones in the preoperative period in elective surgeries.
Evolution of Protocols
Traditionally, absolute fasting ranges from 6 to 8 hours. However, more than 79% of patients fasted for more than 8 hours, according to a Brazilian study developed by Dr. José Eduardo de Aguilar Nascimento. This midnight fasting protocol was instituted to prevent patient regurgitation during surgery and aspiration of gastric contents in the airways during anesthesia induction. After 1955 there was a change to 2 or 3 hours, allowing for clear liquids such as tea and juice.
Today, the ACERTO protocol, based on several studies and the ERAS protocol, states that two hours of fasting is safe and beneficial for the patient, recommending the ingestion of clear liquids containing carbohydrates, especially maltodextrin, between 2 to 3 hours before surgery and receiving anesthesia. The patient arrives at the operating room hydrated and fed.
Central Damage of Extended Fast
If a patient goes without food for hours and undergoes surgery, he may have insulin resistance after surgery. This causes hyperglycemia, increases the chances of catabolism, loss of nitrogen, and lean body mass, among other complications.
Benefits of Preoperative Fasting Abbreviation:
✔ Shorter hospital stay. In the elderly, after orthopedic surgery, the reduction was 64.8% of the time, according to the ACERTO survey;
✔ Lower insulin resistance index;
✔ Improved antioxidant defenses;
✔ Reduced cortisol levels;
✔ Improved hydrogenated balance ;
What is the ACERTO Protocol, according to Dr. José Eduardo de Aguilar Nascimento
– Six hours of solids fast.
– The night before: ingestion of 400 ml of liquid with 12.5% maltodextrin.
– Two hours before: intake of 200 ml of liquid with 12.5% maltodextrin.
The protocol has limitations when the patient has an intestinal obstruction, gastroparesis, severe gastroesophageal disease, history of gastrectomy or gastroplasty, and decompensated diabetes mellitus.
> CarboCH, the ideal dose of carbohydrates for fasting abbreviation!