Einfluss der präoperativen Flüssigkeitszufuhr auf das perioperative Outcome

Strikte Nüchternheitsvorgaben vor Operationen werden heute zunehmend kritisch hinterfragt – denn eine prolongierte Flüssigkeitskarenz ist nachweislich mit einem erhöhten Risiko für postoperative Komplikationen assoziiert. Ziel dieses Beitrags ist es, den Einfluss der präoperativen Flüssigkeitszufuhr auf das perioperative Outcome darzustellen und praxisnahe Empfehlungen für ein modernes, differenziertes Nüchternheitsregime zu geben.

Abstract

Despite guideline recommendations allowing clear fluids up to two hours before anaesthesia, prolonged preoperative fasting remains common. This article summarises current evidence and clinical practice regarding preoperative fluid intake and highlights implications for perioperative management based on selective literature review.
Excessive fluid restriction promotes dehydration and is associated with increased risk of delirium, haemodynamic instability, and acute kidney injury; patient comfort (thirst, anxiety, PONV, pain) is also impaired. Consistent application of the two-hour rule or liberal strategies (“Sip til send”) shortens fasting times, improves thirst and well-being, and is not associated with higher rates of regurgitation or aspiration in current evidence. Intravenous fluid boluses immediately before induction provide short-term stabilisation but do not replace early, preferably oral, rehydration. Vulnerable populations, including paediatric and geriatric patients, appear to benefit most.
Preoperative fluid management should aim to reliably prevent dehydration through patient-centred, evidence-based, and pragmatic strategy. Emerging data suggest that liberal fluid intake regimens may better achieve these objectives than the currently endorsed two-hour restriction from the outdated 2011 ESAIC guideline. Further well-designed implementation studies and adequately powered randomised trials are warranted to confirm safety and effectiveness.

Kernaussagen

• Exsikkose ist ein unabhängiger Risikofaktor für Mortalität.

• Das Risiko für postoperatives Nierenversagen und Delir steigt mit längerer präoperativer Dehydratation.

• Aktuelle Strategien unter Einhaltung einer 2-stündigen Flüssigkeitskarenz bei Erwachsenen begünstigen eine präoperative Dehydratation.

• Liberale Flüssigkeitsregime wie „Trinken bis zum Abruf“ können dazu beitragen, „Postoperative Nausea and Vomiting“ (PONV) und Delir zu vermeiden.

Schlüsselwörter

präoperative Nüchternheit - Flüssigkeitsgabe - postoperatives Outcome - ERAS - PONV - Anästhesiologie - fasting

Keywords

delir - fluid therapy - postoperative outcome - ERAS - PONV - preoperative care - treatment outcome - delirium - anesthesiology

Publication History

Article published online:
25 November 2025

• Literatur

• 1 Jéquier E, Constant F. Water as an essential nutrient: the physiological basis of hydration. Eur J Clin Nutr 2010; 64: 115-123
• 2 Chassagne P, Druesne L, Capet C. et al. Clinical presentation of hypernatremia in elderly patients: a case control study. J Am Geriatr Soc 2006; 54: 1225-1230
• 3 Warren JL, Bacon WE, Harris T. et al. The burden and outcomes associated with dehydration among US elderly, 1991. Am J Public Health 1994; 84: 1265-1269
• 4 Hasegawa Y, Kato K, Ogai K. et al. Need for a consensus definition of chronic dehydration: A scoping review. Drug Discov Ther 2024; 18: 75-79
• 5 Thomas DR, Cote TR, Lawhorne L. et al. Understanding clinical dehydration and its treatment. J Am Med Dir Assoc 2008; 9: 292-301
• 6 Smith I, Kranke P, Murat I. et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2011; 28: 556-569
• 7 Rüggeberg A, Nickel EA. Unrestricted drinking before surgery: an iterative quality improvement study. Anaesthesia 2022; 77: 1386-1394
• 8 Popovic M, Schlenker MB, Goldshtein D. et al. Preoperative fasting for ambulatory cataract surgery: asystematic review. Can J Ophthalmol 2019; 54: 145-149
• 9 Marsman M, Kappen TH, Vernooij LM. et al. Association of a liberal fasting policy of clear fluids before surgery with fasting duration and patient well-being and safety. JAMA Surg 2023; 158: 254-263
• 10 Checketts MR. Fluid fasting before surgery: the ultimate example of medical sophistry?. Anaesthesia 2023; 78: 147-149
• 11 Basit J, Ahmed M, Burhan M. et al. Meta-analysis on comparison of fasting versus no fasting before cardiac catheterization. Cardiol Rev 2025; Apr 22. Online ahead of print
• 12 Sands R, Wiltshire R, Isherwood P. Preoperative fasting guidelines in National Health Service England Trusts: a thirst for progress. Br J Anaesth 2022; 129: e100-e102
• 13 Dalal PG, Malviya S, Cravero J. et al. Reviewing “Nil Per Os” guidance for clear fluids in children before anesthesia: Survey of the Pediatric Anesthesia Leadership Council. Anesth Analg 2025; 140: 507-514
• 14 Gerth MA, Mussmann YM, Buchler B. et al. [Preoperative fasting in children–Experiences with implementing a liberal fasting policy]. Anaesthesiologie 2023; 72: 565-572
• 15 Kratz T, Hinterobermaier J, Timmesfeld N. et al. Pre-operative fluid bolus for improved haemodynamic stability during minor surgery: A prospectively randomized clinical trial. Acta Anaesthesiol Scand 2018; 62: 1215-1222
• 16 Cuthbertson BH, Campbell MK, Stott SA. et al. A pragmatic multi-centre randomised controlled trial of fluid loading in high-risk surgical patients undergoing major elective surgery – the FOCCUS study. Crit Care 2011; 15: R296
• 17 Wellge BE, Trepte CJ, Zöllner C. et al. [Perioperative fluid management]. Chirurg 2020; 91: 121-127
• 18 Stenberg E, Dos Reis Falcao LF, O’Kane M. et al. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update. World J Surg 2022; 46: 729-751
• 19 Maresh CM, Herrera-Soto JA, Armstrong LE. et al. Perceptual responses in the heat after brief intravenous versus oral rehydration. Med Sci Sports Exerc 2001; 33: 1039-1045
• 20 Davies A, Pang WS, Fowler T. et al. Preoperative fasting in the department of plastic surgery. BMJ Open Qual 2018; 7: e000161
• 21 Frykholm P, Schindler E, Sümpelmann R. et al. Preoperative fasting in children: review of existing guidelines and recent developments. Br J Anaesth 2018; 120: 469-474
• 22 Hausel J, Nygren J, Lagerkranser M. et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg 2001; 93: 1344-1350
• 23 İster G, Hacidursunoğlu Erbaş D, Eti Aslan F. The effect of prolonged fasting before surgery on pain and anxiety. J Perianesth Nurs 2025; 40: 377-380
• 24 Saller T, Brenneisen W, Goebel U. et al. [Special considerations in geriatric anesthesiology: Aspects of perioperative management in older adults]. Anaesthesiologie 2025; 74: 315-326
• 25 Volkert D, Delzenne N, Demirkan K. et al. Nutrition for the older adult – Current concepts. Report from an ESPEN symposium. Clin Nutr 2024; 43: 1815-1824
• 26 Weimann A, Breitenstein S, Breuer JP. et al. [Clinical nutrition in surgery. Guidelines of the German Society for Nutritional Medicine]. Chirurg 2014; 85: 320-326
• 27 Amer MA, Smith MD, Herbison GP. et al. Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery. Br J Surg 2017; 104: 187-197
• 28 Ellis RJ, Del Vecchio SJ, Kalma B. et al. Association between preoperative hydration status and acute kidney injury in patients managed surgically for kidney tumours. Int Urol Nephrol 2018; 50: 1211-1217
• 29 Martin GS, Kaufman DA, Marik PE. et al. Perioperative Quality Initiative (POQI) consensus statement on fundamental concepts in perioperative fluid management: fluid responsiveness and venous capacitance. Perioper Med (Lond) 2020; 9: 12
• 30 Steurer MA, Berger TM. [Infusion therapy for neonates, infants and children]. Anaesthesist 2011; 60: 10-22
• 31 Deutsche Gesellschaft für Gerontopsychiatrie und -psychotherapie (DGGPP), Deutsche Gesellschaft für Geriatrie (DGG). S3-Leitlinie „S3-Leitlinie Delir im höheren Lebensalter – Eine transsektoral umsetzbare, interdisziplinär-interprofessionelle Leitlinie zu Delir-Prävention, -Diagnostik und -Therapie beim alten Menschen“. Angemeldet: 08.01.2021; Geplante Fertigstellung: 30.04.2025. AWMF-Registernummer: 109–001. Accessed August 29, 2025 at: https://register.awmf.org/de/leitlinien/detail/109-001
• 32 Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth 2020; 125: 492-504
• 33 Radtke FM, Franck M, MacGuill M. et al. Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anaesthesiol 2010; 27: 411-416
• 34 Li LT, Wang XH, Zuo YB. et al. Effect of preoperative oral carbohydrate on postoperative delirium in elderly patients undergoing lower extremity orthopedic surgery: a prospective randomized trial. J Orthop Surg Res 2025; 20: 191
• 35 Werner A, Conrads H, Rosenberger J. et al. Effects of implementing an enhanced recovery after cardiac surgery protocol with on-table extubation on patient outcome and satisfaction-a before-after study. J Clin Med 2025; 14: 352
• 36 Deeken F, Sanchez A, Rapp MA. et al. Outcomes of a delirium prevention program in older persons after elective surgery: a stepped-wedge cluster randomized clinical trial. JAMA Surg 2022; 157: e216370
• 37 Oshima S, Aoki Y, Kawasaki Y. et al. The effect of oral hydration on the risk or aspiration and hemodynamic stability before the induction of anesthesia: A systematic review and meta-analysis. J Clin Anesth 2018; 49: 7-11
• 38 Nossaman VE, Richardson WS, Wooldridge jr. JB. et al. Duration of Nil Per Os is causal in hospital length of stay following laparoscopic bariatric surgery. Surg Endosc 2017; 31: 1901-1905
• 39 McCracken GC, Montgomery J. Postoperative nausea and vomiting after unrestricted clear fluids before day surgery: A retrospective analysis. Eur J Anaesthesiol 2018; 35: 337-342
• 40 Rüggeberg A, Schindler E, Kranke P. Leitlinien im Wandel – Neues von der “Guideline on perioperative Fasting in Adults” der ESAIC. Anästh Intensivmed 2024; 65: 404-406