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Using a Combination Amino Acid, Carbohydrate, and Micronutrient Beverage for Preoperative Nutrition Allows Safe
Jennifer A Bowden1, Sarah Heath2, Gregory L Snow3
1Summit Brain, Spine, and Orthopedics, Lehi, Utah; Department of Nutrition, Dietetics, and Food Sciences, Brigham Young University, Provo, Utah.
Background:
Appropriate preoperative nutrition is a critical element of positive surgical outcomes and enhanced recovery. Immediately preoperatively, gastric clearance of nutritional intake must be considered for safely providing anesthesia. Despite updates in preoperative fasting guidelines regarding clear liquids, practical implementation of multinutrient preoperative supplements has been hampered by aspiration concerns.
Objective:
The study aim was to provide an objective measurement of gastric clearance times using a multinutrient supplement to confirm an appropriate immediate preoperative window for nutrient provision beyond simple carbohydrates and noncaloric fluids.
Design:
This is a prospective, single-group intervention, gastric ultrasound study.
Participants/Setting:
Fifty-six individuals participated, with 52 adults from the community in the clinic procedure room and 4 patients undergoing spine surgery in the surgical center preoperative area.
Intervention:
Following an overnight fast, participants consumed a 250 mL exemplar amino acid, micronutrient, and carbohydrate-containing supplement and were followed for gastric emptying time.
Main Outcome Measure:
Ultrasound measurements were taken before and after consuming the multinutrient supplement to determine gastric emptying time both qualitatively and quantitatively.
Statistical Analysis:
Analysis included descriptive statistics, a 1-sample t test for gastric emptying, and ordinal and linear regression analysis for participant characteristic relationships.
Key Results:
Ultrasound cross-sectional area determined 57% of subjects were safe for surgery with residuals <1.5 mL/kg by 30 minutes postconsumption, 93% by 60 minutes, and 96% by 75 minutes, including participants taking glucagon-like peptide-1 receptor agonists or having surgery that day (P < .0001 for mean time <120 minutes).
Conclusions:
All participants consuming a 250 mL preoperative exemplar supplement containing 12 g amino acids, select micronutrients, and 45 g carbohydrates had gastric clearance within 2 hours, with a majority safe for surgery within 1 hour, demonstrating effective emptying of amino acids in addition to the standard carbohydrates typically utilized preoperatively and an opportunity to provide more effective preoperative nutrition.
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