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Anyone else NOT NPO for surgery?



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I just did my pre-op nutrition session and was given some instructions that totally caught me off guard. I am to do my pre-op diet up to the day before surgery (OK, no surprise here). Then the evening before surgery I am to drink 32oz of either apple juice, cranberry juice (or the two mixed), or regular gatorade: FULL SUGAR. Then 2-4 hours before surgery I am to drink 16 more oz! Being a nurse this is totally foreign to me. I was "raised" in a world where you are ALWAYS NPO before surgery. They are not worried about the fluids because they pump your stomach when the are starting surgery, so it is empty anyway when surgery actually starts. That is reassuring. The reason they ARE doing it is because they are finding they have better post op results when they "fluid and carb load" prior to surgery. This does make sense. Afterall, we have a history of dehydrating people just before surgery, and we will dehydrate as it is after surgery, so why not hydrate a little longer. And also makes sense with the sugar. Just surprised to hear this and was wondering if other docs have started doing this as well for VSG.

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I was also "raised" in a world of NPO prior to surgery. I'd be interested to see the evidence by which they make this recommendation. Have there been any scientific studies? How did they come upon this practice?

Secondary thought: doesn't this defeat our low or now carb pre-surgical diet that essentially weans us off of high-carb/sugar? I can see the issue pertaining to dehydration, but to give us a sugar bolus seems counterproductive.

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1 minute ago, S@ssen@ch said:

I was also "raised" in a world of NPO prior to surgery. I'd be interested to see the evidence by which they make this recommendation. Have there been any scientific studies? How did they come upon this practice?

Secondary thought: doesn't this defeat our low or now carb pre-surgical diet that essentially weans us off of high-carb/sugar? I can see the issue pertaining to dehydration, but to give us a sugar bolus seems counterproductive.

I was a bit baffled when I was first told this. And it was a group class, so didn't want to ask too much in front of the other patients. I had planned to stay after class to ask her a couple questions in private, but instead I was wisked away before class was over so they can tell me I was approved and follow up with some surgery related issues.

As for the sugar, I think it is just kind of like a pre-op version of giving D5W IV, but orally. It's not like it is long term, so I am not worried about it being counterproductive. Not like I am going to gain a bunch of weight just before surgery just because I had apple juice instead of Water. If anything, the weight I could gain would be water weight. I also feel like I might feel better before surgery because my blood sugar won't be on the low side because I was NPO for so long. And I am a hard stick, so I think this will help them get my IV started. My first concern was aspiration, but she reassured us they empty our stomachs anyway. I also figured that if there IS anything more solid left in my stomach, it would thin it out and make it easier to remove any gastric contents before surgery.

As for the research behind it? Kind of got the feeling it was something HE was tried and liked the outcomes. But not sure. I see the doc on Monday so I am hoping to remember to ask him more about it then. I am very curious as to how this came about, what research is behind it, and what scientific evidence there is to support him.

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I’m a nurse too. My hospital made this change a couple years ago. Rather than NPO after midnight now it’s clears up until 4 hours before surgery. It sure is more comfortable for those late in the day cases!

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2 minutes ago, kristieshannon said:

I’m a nurse too. My hospital made this change a couple years ago. Rather than NPO after midnight now it’s clears up until 4 hours before surgery. It sure is more comfortable for those late in the day cases!

Good to know! I haven't worked in a hospital for quite a few years now, so haven't done a lot of pre-ops in a while! I guess that is how a few of my family members "procedures" have been as well, now that I think about it. But those haven't been major surgeries, so I wasn't correlating the two together.

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I had NPO. After midnight however 2 hours before surgery I had to drink this high carb juice they provided. My surgeon has been practicing for 20 years so maybe it’s old school? There was a rational but I don’t remember the details.

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I always thought it had something to do with people vomiting and aspirating during surgery. That’s why they wanted your stomach empty. I don’t know. I was Clear Liquids until
Midnight and nothing afterward

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17 minutes ago, NYJenn said:

I always thought it had something to do with people vomiting and aspirating during surgery. That’s why they wanted your stomach empty. I don’t know. I was Clear Liquids until
Midnight and nothing afterward

Yes, that is why we always used to make patients NPO. But they aren't worried about that since they are pumping my stomach before they start anyway.

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Well my Bariatric Hospital "The Ohio State University Hospital- WEXNER Medical Center"- if You Think the title is BIG You ought to see the place - those corridors Go On and On and On. And the " The" is an integral part of its title, it's a Trademark registered with the Patent Office. They " Carbo- Load" also, they have a Special Drink made by Abbott Labs , the maker of Ensure, and also headquartered in Columbus Ohio ( anybody Smell a Kick- Back There?) You drink one bottle at Midnight and the other no later than 2 hours before your arrival time at check-in. In my case it was Midnight and 3AM because I was to check in at 5 AM for a 7AM surgery time. I live at least one hour, on non- peak traffic ,from Columbus. I was a Good Little Camper, took Bottle 1 at Midnight, Bottle 2 , Well my childhood friend Kathy picked me up at 3AM , popped the bottle open and just sipped as we rode along instead of Chug-a-lugging like I was expected to. Got there , checked in , donned my plug- ugly patient gown which only comes in 2 sizes, small like "you don'T REALLy NEED. bariatric surgery" and" Fall off your shoulders", I of course was issued the latter. Then they took my Blood Sugar and asked for a specimen of my High Test Urine, told them if you're testing for pregnancy I am 72 years old , been widowed for 6 years, go look out an Eastern Window and check for a 🌟 Star. But no, they test the urine also for Sugar Spillover as well as my blood, and both were high. No I NEVER have been diabetic even though being the Adult child of 2 Diabetics as well as over 300 pounds I sure ought to have been . All because I might have been Happy Camper but a failure as a Weight Loss Private first- class because I DIDN'T FOLLOW ORDERS. So that I didn't miss my OR date, I was first scheduled and if I'm behind, there goes the Surgery Schedule right out the Door. So they started IVs in both arms, went full- bore and WASHED that pesky glucose liquid right out of ME. About at this point my 3 kidneys are going "WTF are you doing?" but the re-test was perfect , down below 65 from 197 and everyone is Happy Happy Happy except my Urinary system! Well Dr Needleman promised if I voided like there was no tomorrow, No Catheter! Did my best, figured if I still wet my bedding in the OR--- its their problem while I'm asleep!
That all said, This Tuesday I am having a Pesky Ganglion cyst REMOVED, doesn't appear THAT LARGE but it is painful and must be overlaying some nerves, when it does ache like a misplaced absessed tooth, my Left Thumb and First Finger go Numb. Now I do not go around pinching people
as a rule, not there aren't people out there who might benefit from a strategic one, but it is nice to be able to tell if you're picking Things up by touch. So I will be NPO from. 11:59.pm tomorrow night for hand surgery which techically could be done with a local or nerve block, I am going " Sleepy-Bye because Dr Doolittle says he doesn't require Comments from the Peanut Gallery while he does his MAGIC. And it is Being done at my local Ding- bat hospital Knox Community Hospital because that's where he has his Staff Privileges. Why DingBat? There was the time they asked my cousin with Obvious GallBladder colic ismf she would like a PAP test, followed right behind them telling me to hold my breath while doing an Lower Arm X-Ray. Now it would be understandable for a Chest Xray but a Limb? Oh-- Come on Folks!

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8 hours ago, momof3_angels said:

I just did my pre-op nutrition session and was given some instructions that totally caught me off guard. I am to do my pre-op diet up to the day before surgery (OK, no surprise here). Then the evening before surgery I am to drink 32oz of either apple juice, cranberry juice (or the two mixed), or regular gatorade: FULL SUGAR. Then 2-4 hours before surgery I am to drink 16 more oz! Being a nurse this is totally foreign to me. I was "raised" in a world where you are ALWAYS NPO before surgery. They are not worried about the fluids because they pump your stomach when the are starting surgery, so it is empty anyway when surgery actually starts. That is reassuring. The reason they ARE doing it is because they are finding they have better post op results when they "fluid and carb load" prior to surgery. This does make sense. Afterall, we have a history of dehydrating people just before surgery, and we will dehydrate as it is after surgery, so why not hydrate a little longer. And also makes sense with the sugar. Just surprised to hear this and was wondering if other docs have started doing this as well for VSG.

That is interesting! Sounds like your surgeon is using ERAS protocols (Enhanced Recovery After Surgery), a more modern evidence- based way of approaching surgery that emphasizes early nutrition and ambulation, non narcotic pain medications, and helps improve patient outcomes and decrease hospital length of stay. Google ERAS if you want to learn more! Carb loading (via a clear drink) pre-op is a huge part of it. I am a PACU nurse and we have ERAS protocols for colorectal, GYN, and pancreatectomy surgeries, but aren’t doing it with WLS yet. Pretty cool!

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4 minutes ago, 303nursemom said:

That is interesting! Sounds like your surgeon is using ERAS protocols (Enhanced Recovery After Surgery), a more modern evidence- based way of approaching surgery that emphasizes early nutrition and ambulation, non narcotic pain medications, and helps improve patient outcomes and decrease hospital length of stay. Google ERAS if you want to learn more! Carb loading (via a clear drink) pre-op is a huge part of it. I am a PACU nurse and we have ERAS protocols for colorectal, GYN, and pancreatectomy surgeries, but aren’t doing it with WLS yet. Pretty cool!

A lot has changed since I worked ICU/CCU/Trauma! I am in a different world of nursing now. No pre-op care to give for me lol. I will go look it up. Thanks for the info!

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I had my surgery a couple days ago and the night before they had me drink 2 Ensure Pre-Surgey drinks and I was to have another one in the AM. Each had 52g of carbs! I was told that it aids in recovery and to be honest I don't know if it was the drinks but I felt pretty darn good after my surgery.

Sent from my SM-G975U using BariatricPal mobile app

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Way to Go, @ cubyblue6, hope things went Sweet, Smooth and Sleek and YOU'RE NOW LIVING the👣 Recovery Life! Just remember, Every Day in Every Way it gets Better and Better🌈😛

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