Zusammenfassung
Die strenge traditionelle präoperative Nahrungskarenz vor elektiven Eingriffen mit
dem Ziel einer Reduktion des perioperativen Aspirationsrisikos wird bereits seit Jahren
kritisch hinterfragt. Insbesondere im Hinblick auf die präoperative Einnahme von klarer
Flüssigkeit wurde gezeigt, dass von einer vollständigen Magenpassage innerhalb von
zwei Stunden sicher ausgegangen werden kann und das Trinken begrenzter Mengen bis
zu diesem Zeitrahmen vor Allgemeinanästhesie ohne erhöhtes Risiko einhergeht. Als
Konsequenz wird neben anästhesiologischen Gesellschaften anderer Länder seit kurzem
auch in Deutschland im Sinne eines verbesserten perioperativen Wohlbefindens offiziell
ein gelockerter Umgang mit der Einnahme flüssiger wie fester Nahrung vor elektiven
Eingriffen empfohlen. Neben dem erhöhten Patientenkomfort scheint die Möglichkeit
einer Optimierung des präoperativen Ernährungszustandes weiter reichende Einflüsse
auf den klinischen Benefit zu haben. Zahlreiche experimentelle wie klinische Studien
zeigen, dass zusätzlich zu dem chirurgischen Trauma präoperatives Fasten per se ein
relevanter metabolischer Stressfaktor darstellt. Durch eine kurzfristige präoperative
Kalorienzufuhr durch beispielsweise die orale Einnahme kohlenhydratreicher klarer
Flüssigkeit kann dagegen eine metabolische Konditionierung erreicht und solchen Faktoren
wie postoperative Insulinresistenz, Proteinkatabolismus und eingeschränkte Organfunktionen
präventiv begegnet werden. Vor diesem Hintergrund sollte das Trinken klarer kalorienreicher
Flüssigkeit bis zwei Stunden vor Narkoseeinleitung nicht nur erlaubt, sondern möglicherweise
routinegemäß verschrieben werden.
Abstract
Over the past several years, the traditional practice of overnight fasting prior to
elective surgery to reduce the risk of pulmonary aspiration has been scientifically
challenged. In particular, the limited intake of clear fluids within two hours has
shown reliable gastric emptying and no increased risk for patients. Because of this,
the official guidelines of the Anaesthesiology Societies of many countries including
Germany have recently been changed. These guidelines recommend more liberal policies
for oral fluid and solid food intake, primarily to decrease perioperative discomfort.
However, improved preoperative nutritional status appears to have other clinically
beneficial effects. Many experimental and clinical studies in the literature have
shown the preoperative fasting state to be a supplementary stress to the surgical
trauma. The short-term preoperative administration of calories, e. g. by oral administration
of carbohydrate-rich clear fluids, may lead to metabolic conditioning and preventively
treat entities such as postoperative insulin resistance, protein catabolism, and organ
dysfunction. Because of this, the administration of calorie-loaded clear fluids prior
to elective surgery should not only be allowed but should be part of routine clinical
practice.
Schlüsselwörter
präoperative Nahrungskarenz - Aspirationsrisiko - Patientenkomfort - präoperative
Ernährung - metabolische Konditionierung
Key words
overnight fasting - risk of aspiration - perioperative discomfort - preoperative nutrition
- metabolic conditioning
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Prof. Dr. med. Claudia Spies
Centrum für Anästhesiologie, Intensivmedizin und OP-Management, Campus Charité Mitte
und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin
Charitéplatz 1
10117 Berlin
Telefon: 030/450531-052
Fax: 030/450531-911
eMail: claudia.spies@charite.de