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Präoperative Nüchternheit 2008

Ärztliches Handeln zwischen Empirie und Wissenschaft

Preoperative fasting 2008

Medical behaviour between empiricism and science

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Zusammenfassung

Ziel präoperativer Nüchternheit ist die Minimierung des Aspirationsrisikos. Perioperative Sicherheit steigt jedoch nicht linear mit der Nüchternheitsdauer. Das traditionelle Gebot völliger Nüchternheit ab Mitternacht basiert auf lückenhaftem Datenmaterial, Überinterpretation und Expertenmeinung. Tatsächlich ist das Gesamtrisiko der klinisch relevanten Aspiration gering, klare Flüssigkeit verbleibt in der Regel nur kurz im Magen und eine Nüchternzeit von 6 h erlaubt beim Gesunden die vollständige Passage fester Nahrung. Die Identifikation der Patienten, die einem erhöhten Aspirationsrisiko ausgesetzt sind, bereitet nach wie vor große Schwierigkeiten. Insbesondere die Bedeutung von Schwangerschaft, Adipositas, Diabetes mellitus, Trauma, Rauchen oder Niereninsuffizienz ist letztlich nicht geklärt. Dies spiegeln auch nationale und internationale Richtlinien zur präoperativen Nahrungs- und Flüssigkeitskarenz wider, die den „Risikopatienten“ zwar z. T. erwähnen, aber nicht exakt definieren. Ein Verzicht auf klare Flüssigkeiten bis 2 h und auf feste Speisen bis 6 h vor anästhesiologischen Verfahren setzt sich zunehmend durch. Muttermilch bei Kindern wird bis 4 h präoperativ toleriert.

Abstract

Preoperative fasting aims at minimizing the risk of pulmonary aspiration. However, perioperative safety does not directly increase with the duration of total abstinence from food and liquids. The traditional principle „nil per os from midnight on“, is based on insufficient data, overinterpretation and expert opinion. In fact, the total perioperative risk of a clinically relevant regurgitation of gastric content is low. Clear liquids are not stored within the stomach for a long time and in the healthy, a fasting period of 6 h allows the total passage of solid food. Identifying those patients with an increased risk of perioperative aspiration is still difficult. In particular, the impact of pregnancy, adipositas and diabetes, trauma, smoking, opioids and renal insufficiency has not been clarified. This lack of knowledge is reflected by national and international guidelines concerning preoperative fasting, which mention the „patient at risk“ without defining it exactly. Abstention from clear liquids 2 h before and of solids 6 h before induction of anesthesia, is becoming increasingly more accepted. Feeding babies with breast milk appears to be tolerated 4 h before anesthesiological procedures.

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Weiß, G., Jacob, M. Präoperative Nüchternheit 2008. Anaesthesist 57, 857–872 (2008). https://doi.org/10.1007/s00101-008-1429-4

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