Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942009000500006
Brazilian Journal of Anesthesiology
Scientific Article

A abreviação do jejum pré-operatório para duas horas com carboidratos aumenta o risco anestésico?

Does abbreviation of preoperative fasting to two hours with carbohydrates increase the anesthetic risk?

Kátia Gomes Bezerra de Oliveira; Maiumy Balsan; Sérgio de Souza Oliveira; José Eduardo Aguilar-Nascimento

http://dx.doi.org/10.1590/S0034-70942009000500006 Braz J Anesthesiol, vol.59, n5, p.577-584, 2009
PDF Português
PDF English
Downloads: 14
Views: 3770

Resumo

JUSTIFICATIVA E OBJETIVOS: O objetivo do presente estudo foi avaliar o surgimento de possíveis complicações anestésicas relacionadas à abreviação do jejum pré-operatório para duas horas com uma solução contendo dextrinomaltose a 12,5% dentro do projeto ACERTO (Aceleração da Recuperação Total Pós-operatória). MÉTODO: Foram avaliados prospectivamente todos os pacientes submetidos a diversas operações sobre o trato digestivo e parede abdominal dentro de um novo protocolo de condutas perioperatórias estabelecidas pelo projeto ACERTO entre agosto de 2005 e dezembro de 2007. Todos receberam o suplemento nutricional (dextrinomaltose a 12,5%) por via oral seis e duas horas antes do procedimento cirúrgico. A coleta de dados foi prospectiva sem o conhecimento dos profissionais do serviço. Observou-se o tempo de jejum pré-operatório e as complicações anestésicas relacionadas ao curto tempo de jejum (broncoaspiração). RESULTADOS: Foram avaliados 375 pacientes, sendo 174 homens (46,4%) e 201 mulheres (53,6%) entre 18 e 90 anos de idade O tempo médio de jejum pré-operatório foi de quatro horas variando de duas a 20 horas. Não houve nenhum caso de broncoaspiração durante os procedimentos. O tempo de jejum foi maior (p < 0,01) quando se praticou procedimento anestésico associado (bloqueio + geral). CONCLUSÕES: A adoção das medidas multidisciplinares perioperatórias do projeto ACERTO não trouxe nenhuma complicação relacionada ao jejum pré-operatório. A dextrinomaltose é suplemento nutricional útil e seguro para o paciente.

Palavras-chave

ANESTESIA, COMPLICAÇÕES, JEJUM

Abstract

BACKGROUND AND OBJECTIVES: The objective of the present study was to evaluate the incidence of possible anesthetic complications related with the abbreviation of preoperative fasting to two hours with a solution of 12.5% dextrinomaltose within the ACERTO (from the Portuguese for Acceleration of Total Postoperative Recovery) project. METHODS: All patients undergoing different types of digestive tract and abdominal wall surgeries within a new protocol of perioperative conducts, established by the ACERTO project, between August 2005 and December 2007 were evaluated. All patients received oral nutritional supplementation (12.5% dextrinomaltose) six and two hours before the procedure. Data were collected prospectively without the knowledge of the professionals in the department. The length of preoperative fasting and anesthetic complications related with the short fasting time (pulmonary aspiration) were recorded. RESULTS: Three hundred and seventy five patients, 174 male (46.4%) and 201 female (53.6%), ages 18 to 90 years, were evaluated. The mean preoperative fasting time was four hours, ranging from two to 20 hours. Pulmonary aspiration was not observed during the procedures. The length of fasting was longer (p < 0.01) when combined anesthesia (blockade + general) was used. CONCLUSIONS: Adopting the multidisciplinary preoperative measures of the ACERTO project was not associated with any preoperative fasting-associated complications. Dextrinomaltose is a useful and safe nutritional supplement for the patient.

Keywords

ANESTHESIA, COMPLICATIONS, FASTING

References

Maltby JR. Fasting from midnight: the history behind the dogma. Best Pract Res Clin Anaesthesiol. 2006;20:363-378.

Brener W, Hendrix TR, McHugh PR. Regulation of gastric emptying of glucose. Gastroenterology. 1983;85:76-82.

Noblett SE, Watson DS, Huong H. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis. 2006;8:563-569.

Melis GC, van Leeuwen PA, von Blomberg-van der Flier BM. A carbohydrate-rich beverage prior to surgery prevents surgery-induced immunodepression: a randomized, controlled, clinical trial. JPEN J Parenter Enteral Nutr. 2006;30:21-26.

Nygren J, Thorell A, Jacobsson H. Preoperative gastric emptying: Effects of anxiety and oral carbohydrate administration. Ann Surg. 1995;222:728-734.

Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent preoperative complications. Cochrane Database Syst Rev. 2003:CD004423.

Aguilar-Nascimento JE, Bicudo-Salomão A, Caporossi C. Acerto pós-operatório: avaliação dos resultados da implantação de um protocolo multidisciplinar de cuidados peri-operatórios em cirurgia geral. Rev Col Bras Cir. 2006;33:181-188.

Aguilar-Nascimento JE, Bicudo-Salomão A, Caporossi C. Enhancing surgical recovery in Central-West Brazil: The ACERTO protocol results. e-SPEN. Eur J Clin Nutr Metab. 2008;3:e78-e83.

Correia MITD, da Silva RG. Paradigmas e evidências da nutrição peri-operatória. Rev Col Bras Cir. 2005;32:342-347.

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. 1999;90:896-905.

Martins FANC, Amaral JLG. Esvaziamento gástrico após administração oral de contraste em tomografia computadorizada do abdômen: Descrição de seis casos. Rev Bras Anestesiol. 2004;54:361-370.

Pearse R, Rajakulendran Y. Pre-operative fasting and administration of regular medications in adult patients presenting for elective surgery: Has the new evidence changed practice?. Eur J Anaesthesiol. 1999;16:565-568.

Cruvinel MGC, Bittencourt PFS, Costa JRR. Volume gástrico residual e risco de aspiração pulmonar em crianças com refluxo gastroesofágico: Estudo comparativo. Rev Bras Anestesiol. 2004;54:37-42.

Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630-641.

Ljungqvist O, Soreide E. Preoperative fasting. Br J Surg. 2003;90:400-406.

Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate nutrition: an update. Curr Opin Clin Nutr Metab Care. 2001;4:255-259.

Hellstrom PM, Gryback P, Jacobsson H. The physiology of gastric emptying. Best Pract Res Clin Anaesthesiol. 2006;20:397-407.

5dd5996c0e88252a09c8fca6 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections