NPO, ERAS, Total joints

[facted]

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What are you guys doing for total joints in terms of NPO/ERAS?

We recently started having the patients take 32oz Gatorade a few hours before the procedure and I've started seeing some cases of regurgitation during our spinal/50mcg/kg propofol anesthetic.

Really wasn't having issues with this before and I'm thinking clears prior to surgery is one thing and 32oz of clears with high glucose load is another.

What do you guys think?

 

[okayplayer]

Not surprising and an obvious corollary to force feeding as much clear liquid as possible as close to possible before surgery.

 

[Beach bum]

What are you guys doing for total joints in terms of NPO/ERAS?

We recently started having the patients take 32oz Gatorade a few hours before the procedure and I've started seeing some cases of regurgitation during our spinal/50mcg/kg propofol anesthetic.

Really wasn't having issues with this before and I'm thinking clears prior to surgery is one thing and 32oz of clears with high glucose load is another.

What do you guys think?

If I drank that much Gatorade a few hours prior to surgery I’d probs be puking it. Never been a fan of “rote” medicine. That is what the crnas I work with do. Generally have no’s idea why they are doing what they do.....

 

[Iso4ane]

What are you guys doing for total joints in terms of NPO/ERAS?

We recently started having the patients take 32oz Gatorade a few hours before the procedure and I've started seeing some cases of regurgitation during our spinal/50mcg/kg propofol anesthetic.

Really wasn't having issues with this before and I'm thinking clears prior to surgery is one thing and 32oz of clears with high glucose load is another.

What do you guys think?

32oz as in a quart, as in four cups? Like half of ones daily recommended fluid intake? Seem like a lot of fluid at once. I though prior studies used half that. Or at least if it was ~1000mls it was in divided doses.

 

[Ezekiel2517]

What flavor Gatorade?

 

[dhb]

What flavor Gatorade?

Purple drank?

 

[Ezekiel2517]

Purple drank?

You're basically playing with fire with this one. Better to have the patient guzzle a liter of bicitra

 

[pgg]

32 oz of Gatorade? What, are we afraid the obese diabetic who held his insulin is going to become symptomatically hypoglycemic if his glucose falls below 200 preop?

Insanity.

 

[okayplayer]

Hey, it’s our society whose guidelines don’t distinguish between 2 oz of water and 64 oz of Gatorade 2 h before surgery. It makes zero sense but medioclegally and with surgeons who want this ERAS stuff they are putting us in a terrible corner here.

Also, I understand pushing clears somewhat in patients having bowel surgery. Why the necessity for a total knee (most of which take 2 hours and lose maybe 200ml of blood)?

 

[Mman]

Hey, it’s our society whose guidelines don’t distinguish between 2 oz of water and 64 oz of Gatorade 2 h before surgery. It makes zero sense but medioclegally and with surgeons who want this ERAS stuff they are putting us in a terrible corner here.

To be fair it's also radiological gastric emptying studies that show there is no difference.

Personally for a joint, 16 oz 3-4 hours before surgery is probably fine. The ERAS fluid stuff is more important in bowel surgery where you want to avoid bowel edema and delayed bowel function from large volumes of IV fluid.

 

[OB1🤙]

It doesn't fit with this crazy new world of one size fits all protocols, but here's a crazy thought:

Tell the patient "If you're thirsty, have some water or Gatorade up to 2 hours before surgery. How much? Stop when you're not thirsty anymore."

 

[T-burglar]

I’m laughing pretty hard imagining forcing patients to chug and then hitting em with the spinal and the propofol until they vomit

 

[deleted87051]

I must be missing the boat so I’ll ask, which outcome measure are they trying to improve with this practice? Nausea? Pain? Time to ambulation? Time to discharge? Patient satisfaction?


What’s the point?

 

[deleted162650]

I must be missing the boat so I’ll ask, which outcome measure are they trying to improve with this practice? Nausea? Pain? Time to ambulation? Time to discharge? Patient satisfaction?


What’s the point?

They had a spare box to check. Needed to fill it with something.

 

[facted]

I agree with all of you. That's why I wanted to know what everyone else is doing before fighting back. But this is ridiculous.

 

[acidbase1]

And the point of the Gatorade?

 

[caveat87]

And the point of the Gatorade?

But seriously there is some theory about loading with carbohydrate rich fluids leading to less insulin resistance and muscle catabolism

 

[Ronin786]

I must be missing the boat so I’ll ask, which outcome measure are they trying to improve with this practice? Nausea? Pain? Time to ambulation? Time to discharge? Patient satisfaction?


What’s the point?

Primary outcome: decreased days spent alive.

 

[sleepallday]

I must be missing the boat so I’ll ask, which outcome measure are they trying to improve with this practice? Nausea? Pain? Time to ambulation? Time to discharge? Patient satisfaction?


What’s the point?

Supposedly, the pre-operative carbohydrate load reduces insulin resistance post operatively.

We do it to, but it's only a 10oz clear carb drink. 32oz sounds nuts.
https://abbottnutrition.com/ensure-pre-surgery

 

[deleted697127]

View attachment 230165
But seriously there is some theory about loading with carbohydrate rich fluids leading to less insulin resistance and muscle catabolism

Coffee and no breakfast will limit your gainz

 

[Psai]

It doesn't fit with this crazy new world of one size fits all protocols, but here's a crazy thought:

Tell the patient "If you're thirsty, have some water or Gatorade up to 2 hours before surgery. How much? Stop when you're not thirsty anymore."

Mmmm yeahhh...did you see the memo? It's just we're using this new protocol for all patients indiscriminately. If you could just go ahead and just make sure you do that from now on that'd be greaaatt.