The End of the 'NPO After Midnight' Rule
For decades, patients were instructed to consume nothing by mouth (NPO) after midnight before surgery. The rule was based on the risk of aspiration pneumonia, a serious complication that can occur if stomach contents enter the lungs under anesthesia. While intended for safety, this blanket rule resulted in unnecessarily long fasting periods, leading to patient dehydration, thirst, hunger, and fatigue. Research over the last two decades has revolutionized this practice, demonstrating that consuming certain fluids much closer to the time of surgery is safe and highly beneficial.
The Enhanced Recovery After Surgery (ERAS) Protocol
Modern medical centers now embrace Enhanced Recovery After Surgery (ERAS) protocols, which prioritize improved patient comfort and faster recovery by addressing key metabolic and physiological challenges related to surgery. A core component of ERAS is a revised approach to preoperative fasting. Instead of prolonged starvation, patients are encouraged to consume specific fluids to maintain hydration and energy levels.
What You Can Drink Before Surgery: The Clear Fluid Rule
For most elective procedures, healthy patients are allowed to have clear liquids up to two hours before anesthesia. A clear liquid is defined as any liquid you can see through, and it leaves the stomach quickly, typically within 60 to 90 minutes.
Examples of approved clear liquids include:
- Water
- Clear, pulp-free fruit juices, such as apple or white grape juice
- Black coffee or plain tea (no milk, cream, or milk-based whiteners)
- Sports drinks like Gatorade or Powerade (specific colors may be restricted, such as red or purple)
- Clear sodas like Sprite or 7-Up
- Nutritionally balanced, medical-grade clear carbohydrate drinks
Liquids to Avoid
It is crucial to avoid any liquid that is not transparent or contains milk, fat, or pulp. These take longer to digest and can increase the risk of complications.
Liquids to avoid include:
- Milk and all dairy products (takes longer to digest and is considered a solid)
- Orange juice or other pulpy juices
- Smoothies or protein shakes
- Alcoholic beverages (interferes with anesthesia and affects recovery)
- Heavy broths or soups
The Role of Preoperative Carbohydrate Loading
One of the most significant advances in pre-surgical nutrition is carbohydrate loading. This involves drinking a specialized clear carbohydrate beverage, such as Ensure Pre-Surgery, before the procedure. These drinks are part of ERAS protocols and provide several key benefits.
Benefits of Preoperative Carbohydrate Loading
- Reduces Postoperative Nausea and Vomiting (PONV): Studies show that patients who consume carbohydrate drinks experience less nausea and vomiting after surgery.
- Stabilizes Blood Sugar: The carbohydrates help stabilize blood glucose levels, especially important for longer surgeries or for patients with well-controlled diabetes (with medical supervision).
- Decreases Insulin Resistance: Surgical stress can cause insulin resistance. Preoperative carb loading helps mitigate this effect, promoting a healthier metabolic response.
- Lessen Hunger and Thirst: These drinks significantly improve patient comfort by reducing the feelings of hunger, thirst, and anxiety associated with fasting.
- Supports Earlier Recovery and Discharge: By reducing the body's stress response and improving overall well-being, carb loading can potentially lead to a shorter hospital stay.
Traditional Fasting vs. Modern ERAS Protocol
| Feature | Traditional Fasting Protocol | Modern ERAS Protocol |
|---|---|---|
| Clear Liquids | Restricted after midnight before surgery | Allowed up to 2 hours before anesthesia |
| Carbohydrate Drinks | Not included | Often prescribed the night before and again 2-3 hours before surgery |
| Patient Comfort | Often leads to significant thirst, hunger, and malaise | Improves well-being by reducing hunger and anxiety |
| Metabolic State | Puts the body in a catabolic (breakdown) state | Creates an anabolic (building) state, improving insulin sensitivity |
| Recovery | Can result in slower recovery and longer hospital stays | Aims for faster recovery and reduced hospital stay duration |
| Safety | Considered safe but causes unnecessary discomfort | Evidence-based to be safe and more comfortable for most patients |
Conclusion: Personalized Pre-Surgical Hydration is Key
The question of what is the drink you drink before surgery? is no longer answered with a universal rule of nothing. The shift towards modern, evidence-based practices like the ERAS protocol allows for a more comfortable and effective preparation for surgery. The administration of clear fluids, and in many cases, specialized carbohydrate drinks, helps maintain hydration, stabilize blood sugar, and reduce the body's stress response to the procedure. Always follow the specific, individualized instructions provided by your surgical team, as they tailor the plan to your health status and the type of surgery you are having. Proper nutrition and hydration before surgery set the stage for a smoother recovery and better overall outcome. For more information, consult the guidelines of the American Society for Enhanced Recovery (ASER) or your local hospital's surgical care department.
Follow Your Doctor's Orders
Adhering to your surgeon and anesthesiologist's instructions is the most important part of your pre-surgical preparation. Deviating from the plan, even with fluids, can lead to your procedure being delayed or cancelled for your safety. If you are a diabetic patient, it is especially critical to follow the specialized plan your doctor outlines, as it will include specific guidance for carbohydrate loading and insulin management.
Importance of Staying Hydrated
Beyond just the immediate hours before surgery, staying well-hydrated in the days leading up to your procedure is important. Hydration supports overall health, helps with wound healing, and ensures stable blood pressure during the procedure. Your surgical team may recommend increasing your fluid intake in the days leading up to surgery, so be sure to discuss this with them during your pre-operative assessment.
