Shortened preoperative fasting for prevention of complications associated with laparoscopic cholecystectomy: a meta-analysis

Abstract

ObjectiveRoutine fasting (12 h) is always applied before laparoscopic cholecystectomy, but prolonged preoperative fasting causes thirst, hunger, and irritability as well as dehydration, low blood glucose, insulin resistance and other adverse reactions. We assessed the safety and efficacy of a shortened preoperative fasting period in patients undergoing laparoscopic cholecystectomy.MethodsWe searched PubMed, Embase and Cochrane Central Register of Controlled Trials up to 20 November 2015 and selected controlled trials with a shortened fasting time before laparoscopic cholecystectomy. We assessed the results by performing a meta-analysis using a variety of outcome measures and investigated the heterogeneity by subgroup analysis.ResultsEleven trials were included. Forest plots showed that a shortened fasting time reduced the operative risk and patient discomfort. A shortened fasting time also reduced postoperative nausea and vomiting as well as operative vomiting. With respect to glucose metabolism, a shortened fasting time significantly reduced abnormalities in the ratio of insulin sensitivity. The C-reactive protein concentration was also reduced by a shortened fasting time.ConclusionsA shortened preoperative fasting time increases patients’ postoperative comfort, improves insulin resistance, and reduces stress responses. This evidence supports the clinical application of a shortened fasting time before laparoscopic cholecystectomy.

Postoperative complications in Chinese children following dental general anesthesia

“…[ 11 , 17 , 21 ] A meta-analysis by Xu et al showed that a shortened fasting time reduced postoperative nausea and vomiting after laparoscopic cholecystectomy under general anesthesia. [ 33 ] It is speculated that children's gastrointestinal tracts might be in a state of stress due to long fasting time, which was at least 6 hours in our study. Atan et al [ 5 ] showed that for every 10-minute increase in anesthetic time, patients aged 6 to 16 years exhibited a 15% increase in the odds of feeling sleepy and a 19% increase in the odds of feeling nauseous following DGA.…”

Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies

“…Awad et al 32 conducted a meta-analysis which included abdominal, thyroid, and cardiac surgeries, and found limited evidence that preoperative carbohydrate alters the risk of PONV. A more recent meta-analysis by Xu et al 33 looking into laparoscopic cholecystectomy reported that carbohydrate beverage before surgery was associated with significantly lower risk of postoperative vomiting.…”

Enhanced recovery after surgery review and urology applications in 2020

“…Numerous studies have demonstrated that cessation of solid food and liquid intake, starting at midnight is associated with a number of metabolic derangements, including insulin resistance . Shortening this period improves patients' comfort and reduces the surgical stress response . Current guidelines by the ERAS society allows the intake of clear fluids up to 2 hours and solid foods up to 8 hours prior to surgery …”

“…3 Shortening this period improves patients' comfort and reduces the surgical stress response. 11 Current guidelines by the ERAS society allows the intake of clear fluids up to 2 hours and solid foods up to 8 hours prior to surgery. 3 In the Cochrane Database, a review including 27 trials, demonstrated that preoperative carbohydrate loading was associated with a slightly decreased hospital LOS without affecting postoperative complication rates when compared with fasting and placebo.…”