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restriction from the outdated 2011 ESAIC guideline.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.
Schlüsselwörter
präoperative Nüchternheit - Flüssigkeitsgabe - postoperatives Outcome - ERAS - PONV
- Anästhesiologie - fasting
Keywords
delir - fluid therapy - postoperative outcome - ERAS - PONV - preoperative care -
treatment outcome - delirium - anesthesiology
