Die präoperative Nüchternheit ist ein wichtiges, viel diskutiertes Thema in der
anästhesiologischen Praxis. Zuletzt wurden neben dem traditionellen Fokus auf die
Verminderung des Aspirationsrisikos auch die pathophysiologischen Folgen (zu) langer
Nüchternzeiten in die Überlegungen mit einbezogen. Ziel ist, nicht mehr ausschließlich
eine
standardisierte Empfehlung, sondern optimale, für die individuellen Patientengruppen
zugeschnittene Nüchternzeiten zu gewährleisten [1]
[2]
[3]
[4].
Abstract
Recommendations regarding preoperative fasting have been an integral part of
anaesthesiological practice for decades. In recent years, in addition to the traditional
focus on reducing the risk of aspiration, the pathophysiological consequences of
(excessively) long fasting periods have increasingly been taken into consideration.
The
aim is no longer exclusively to provide standardised recommendations that are applicable
to as large a group of patients as possible, but to achieve implementation that
results
in short, realistic fasting periods for patients.
It remains important to reliably
identify patients who are at potentially increased risk of perioperative aspiration
to
individually adjust not only the immediate perioperative procedure but also the
preoperative fasting periods. Patients with delayed gastric emptying play a significant
role in this context. This can occur idiopathically but also in the context of
comorbidities such as diabetes mellitus, Parkinson’s disease, autoimmune diseases,
diseases of the autonomic nervous system or connective tissue (e.g. scleroderma),
infections of the gastrointestinal tract or after previous major surgery. In addition,
numerous medications – including opioids, tricyclic antidepressants and GLP-1 receptor
agonists in particular – can lead to significant delayed gastric
emptying.
Particularly vulnerable risk groups in connection with excessively long
fasting periods are children, the very elderly and frail, pregnant women and women
in
labour. These groups must be protected from excessively long fasting periods because
they have limited compensatory mechanisms.
The following overview provides an update
on preoperative fasting in children, older people and pregnant women and presents
further risk constellations associated with delayed gastric emptying. It can be
seen as
a best practice recommendation for specific issues.
Schlüsselwörter
Anästhesie - Nüchternheit - Nüchternzeit - Kinder - ältere Patienten - Zerebralparese
- Schwangere - Sectio caesarea - Sondenernährung
Keywords
fasting - children - pregnancy - old patients - cerebral paresis
