This is the 4915th article of Da Yi Xiao Nursing
Enhanced recovery after surgery (ERAS) is a series of optimization measures with evidence-based medical evidence applied in the perioperative period to alleviate the psychological and physical traumatic stress response of patients, so as to achieve the purpose of accelerating the recovery of patients. With the continuous advancement of medical technology, the concept of Enhanced Recovery Surgery (ERAS) has become an important trend in modern surgical treatment. The concept emphasizes reducing surgical stress and speeding up patient recovery by optimizing preoperative, intraoperative, and postoperative management measures. Among them, the dietary management of perioperative patients, as an important part of ERAS, plays a crucial role in the speed and quality of recovery of patients. Below, we will discuss in detail how perioperative hospitalized patients should eat.
1. Preoperative dietary preparation
First of all, under the ERAS concept, the preoperative diet preparation should not only consider the needs of the operation, but also pay attention to the nutritional status and psychological state of the patient. Patients should be encouraged to consume high-protein, high-vitamin, and high-fiber foods before surgery, and ensure that the protein is ≥ 18g per meal before surgery, and the optional foods include eggs, fish, lean meat, and dairy products to maintain a good nutritional status. At the same time, it is important to avoid eating too much greasy, hard-to-digest food to avoid increasing the risk of surgery. Patients with malnutrition can be treated with oral nutritional supplements or enteral nutrition support under the guidance of a physician.
Secondly, it is common knowledge that everyone knows that you should abstain from eating and drinking before surgery. But why should I abstain from water before surgery? How long should I fast and drink? With the implementation of accelerated recovery surgery, there is a new concept of the time to fast and drink before surgery.
Why fast?
Eating and drinking are fasted before surgery to allow the stomach to empty sufficiently and to reduce the risk of regurgitation, vomiting, and aspiration of gastric contents during anesthesia and during surgery.
How to fasting and drinking scientifically?
Since eating before surgery may lead to aspiration, is it safer to fast for longer periods of time?
Of course not, fasting for too long will cause a series of adverse reactions in patients, such as thirst, dehydration, hunger, hypoglycemia, electrolyte imbalance and other surgical stress reactions, which is not conducive to the operation of surgery, and will also cause blood pressure or blood sugar fluctuations in some patients with hypertension or hyperglycemia, which is not conducive to the safety of surgery and anesthesia. Therefore, scientific fasting and drinking water can help alleviate dry mouth and hunger in the early postoperative period and reduce stress response. Scientific recommendation: water abstinence 2 hours before surgery; Solid starchy foods are prohibited for 6 hours; Avoid fatty solid foods for 8 hours.
Relevant guidelines are recommended
(1) The Canadian Society of Anesthesiologists' 2006 anesthesia practice guidelines recommend: 8 hours after fasting from eating meat, fried, and high-fat foods. 6 hours after a bland diet or consumption of dairy products (other than breast milk); 2 hours after abstaining from drinking residue-free liquid. The anesthesiologist should take into account the clinical situation of patients of different ages and flexibly adjust the timing of fasting and drinking.
(2) The 2011 anesthesia practice guidelines of the American Society of Anesthesiologists recommend: light diet can be consumed 6 hours before surgery; Eating meat, fried and high-fat foods requires at least 8 hours between surgery; Residue-free liquid can be drunk 2 hours before surgery.
(3) The 2011 edition of the anaesthesia practice guidelines of the European Association of Anesthesiologists recommends that patients undergoing elective surgery, including cesarean section, should be encouraged to drink slag-free fluids 2 hours before surgery; Adults should abstain from solid food for 6 hours before elective surgery.
How is fasting and drinking enforced?
(1) A ≤ 400 mL of clear drinks can be taken orally 2 hours before surgery, including: water, sugar water, residue-free juice, carbonated drinks, clear tea, black coffee (excluding milk), etc., and of course, special oral carbohydrate drinks. It is important to note that clear drinks ≠ liquid, excluding alcoholic beverages, rice soup, vegetable soup, milk, and milk dairy products. The amount of clear drink that can be consumed 2 hours before anesthesia should be ≤5ml/kg or the total amount ≤ 400ml (not applicable to all patients, according to the doctor's guidance).
How do I eat the night before surgery?
(2) Dinner the day before the operation, you can eat the dinner issued by the nutrition department according to the doctor's instructions, and after dinner about 10 o'clock, you can add meals according to the patient's condition, and it is recommended to focus on easy-to-digest foods, such as: lotus root flour, pumpkin porridge, rice soup, etc.
(3) Avoid meat, frying, and high-fat foods for 8 hours before surgery.
2. Eating early postoperatively
Traditionally, patients are required to fast for long periods of time after surgery, but the ERAS philosophy advocates that drinking and eating should be started as soon as possible after awakening from general anesthesia. Early feeding can reduce the occurrence of postoperative hypokalemia, promote gastrointestinal peristalsis, reduce the occurrence of complications such as postoperative intestinal obstruction, and help restore the patient's appetite and nutrient intake, and speed up postoperative recovery. The criteria for anesthetic awakening are mobility of the limbs, deep breathing and effective coughing, stable blood pressure, complete consciousness, and normal skin and mucosal color. After the patient is awake from anesthesia, he can drink water or eat a small liquid diet after deep breathing and effective cough under the guidance of the nurse, and can eat soft or general food after the gastrointestinal function is restored 4-6 hours after surgery.
3. Reasonable nutrition
Under the ERAS concept, the postoperative patient's diet should focus on balanced nutrition and reasonable combination. Adequate intake of nutrients such as proteins, carbohydrates, fats, vitamins and minerals should be ensured. Choose high-quality protein foods such as lean meats, fish, eggs, and milk, as well as vitamin- and mineral-rich foods such as fresh vegetables and fruits. At the same time, it is necessary to avoid eating too much high-fat, high-sugar, and high-salt foods, so as not to affect the recovery and health of patients.
Protein is recommended food
Fish, chicken breast, tofu, eggs, dairy products, etc.
Suggested Recipe: Consume at least 1-2 servings of high-quality protein-rich foods per day.
Breakfast can be served with eggs and milk;
Lunch with a choice of chicken breast or fish;
Try tofu or dairy products for dinner to provide your body with a consistent and stable amount of protein.
Vitamins are recommended foods
Tomatoes, rape, cabbage, cauliflower, cherries, citrus, kiwi, etc.
Suggested Diet: Consume at least 2-3 servings of vitamin C-rich foods per day.
For breakfast or lunch, choose a citrus fruit;
Choose a serving of sautéed broccoli or potatoes for dinner and let the vitamin C promote wound healing.
Zinc is recommended as a food
Red meat, fish and shellfish, dairy products, eggs, cabbage, fungus, nuts.
Suggested Diet: Make sure you get the right amount of zinc every day.
For lunch or dinner, choose a serving of zinc-rich foods such as lean meats and legumes to help with zinc healing.
4. Individualized diet plan
Each patient's physical condition and type of surgery are different, so perioperative dietary management also needs to be individualized. Doctors should develop a personalized diet plan based on the patient's specific situation, including the type, quantity, timing, and manner of eating. For patients with special dietary requirements, such as diabetic patients, hypertension patients, etc., dietary adjustments should be made under the guidance of a doctor.
5. Psychological adjustment and dietary guidance
Under the ERAS concept, the psychological adjustment of patients is also an important aspect of perioperative dietary management. Doctors should pay attention to the patient's psychological state and provide psychological counseling and support in a timely manner. At the same time, the importance and precautions of perioperative diet should be introduced to patients in detail, so as to help patients establish correct dietary concepts and habits.
In conclusion, under the ERAS concept, the dietary management of perioperative inpatients plays a crucial role in the speed and quality of recovery of patients. Through reasonable preoperative dietary preparation, early postoperative eating, reasonable nutrition, individualized diet plan, psychological adjustment and dietary guidance, the recovery process of patients can be accelerated and the quality of life of patients can be improved.
Author: Emergency Trauma Treatment Center, Shanghai Tongji Hospital
Yang Xiuxia
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