術前飲食のevidence─麻酔科医にとっての安全を求めて
米国やEU加盟諸国と同様に，わが国でも術前における体液管理は患者および医療従事者への負担を考慮し，今後は，経口的な補水療法へ代わると考える．その際に，麻酔科医は術前飲食に関する科学的根拠を持ち，飲料を摂取させる目的を明確に示して，麻酔科医自らが各施設で使用していく飲料を選択すべきと考える．著者は，術前の経口的な液体摂取を患者にも麻酔科医にも安全に提供する補水方法として，次の二つの条件を兼ね備えた方法が望ましいと考えている．一つ目の条件は，輸液療法と同等の水分・電解質補給効果を有する補水方法であること．二つ目の条件は，摂取した飲料が胃から迅速に小腸に排出される補水方法であること．著者は，術前経口...
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| Published in | 日本臨床麻酔学会誌 Vol. 31; no. 7; pp. 959 - 971 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床麻酔学会
2011
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-4945 1349-9149 |
| DOI | 10.2199/jjsca.31.959 |
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| Abstract | 米国やEU加盟諸国と同様に，わが国でも術前における体液管理は患者および医療従事者への負担を考慮し，今後は，経口的な補水療法へ代わると考える．その際に，麻酔科医は術前飲食に関する科学的根拠を持ち，飲料を摂取させる目的を明確に示して，麻酔科医自らが各施設で使用していく飲料を選択すべきと考える．著者は，術前の経口的な液体摂取を患者にも麻酔科医にも安全に提供する補水方法として，次の二つの条件を兼ね備えた方法が望ましいと考えている．一つ目の条件は，輸液療法と同等の水分・電解質補給効果を有する補水方法であること．二つ目の条件は，摂取した飲料が胃から迅速に小腸に排出される補水方法であること．著者は，術前経口補水療法はこの二つの条件を満たしているので，術前の経口的な体液管理に最も適していると考える． |
|---|---|
| AbstractList | [要旨] 米国やEU加盟諸国と同様に, わが国でも術前における体液管理は患者および医療従事者への負担を考慮し, 今後は, 経口的な補水療法へ代わると考える. その際に, 麻酔科医は術前飲食に関する科学的根拠を持ち, 飲料を摂取させる目的を明確に示して, 麻酔科医自らが各施設で使用していく飲料を選択すべきと考える. 著者は, 術前の経口的な液体摂取を患者にも麻酔科医にも安全に提供する補水方法として, 次の二つの条件を兼ね備えた方法が望ましいと考えている. 一つ目の条件は, 輸液療法と同等の水分・電解質補給効果を有する補水方法であること. 二つ目の条件は, 摂取した飲料が胃から迅速に小腸に排出される補水方法であること. 著者は, 術前経口補水療法はこの二つの条件を満たしているので, 術前の経口的な体液管理に最も適していると考える. 「はじめに」近年, 術後回復能力を強化するためのプログラムが考案され, 周術期全体の絶飲食期間が短縮する傾向にある1）2）. 米国やEU加盟諸国と同様に，わが国でも術前における体液管理は患者および医療従事者への負担を考慮し，今後は，経口的な補水療法へ代わると考える．その際に，麻酔科医は術前飲食に関する科学的根拠を持ち，飲料を摂取させる目的を明確に示して，麻酔科医自らが各施設で使用していく飲料を選択すべきと考える．著者は，術前の経口的な液体摂取を患者にも麻酔科医にも安全に提供する補水方法として，次の二つの条件を兼ね備えた方法が望ましいと考えている．一つ目の条件は，輸液療法と同等の水分・電解質補給効果を有する補水方法であること．二つ目の条件は，摂取した飲料が胃から迅速に小腸に排出される補水方法であること．著者は，術前経口補水療法はこの二つの条件を満たしているので，術前の経口的な体液管理に最も適していると考える． |
| Author | 谷口, 英喜 |
| Author_FL | TANIGUCHI Hideki |
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| References | 12) Slim K, Vicaut E, Panis Y, et al.: Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 91: 1125-1130, 2004 26) Patrick A, Epstein O: Review article: gastroparesis. Aliment Pharmacol Ther 27: 724-740, 2008 5) Lobo DN, Hendry PO, Rodrigues G, et al.: Gastric emptying of three liquid oral preoperative metabolic preconditioning regimens measured by magnetic resonance imaging in healthy adult volunteers: a randomised double-blind, crossover study. Clin Nutr 28: 636-641, 2009 6) Mendelson CL: The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 52: 191-205, 1946 3) Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology 106: 843-863, 2007 16) Lobo DN, Macafee DA, Allison SP: How perioperative fluid balance influences postoperative outcomes. Best Pract Res Clin Anaesthesiol 20: 439-455, 2006 19) Meyer JH, Elashoff JD, Lake R: Gastric emptying of indigestible versus digestible oils and solid fats in normal humans. Dig Dis Sci 44: 1076-1082, 1999 28) Reis Lde A, Reis GF, Oliveira MR: The airways and gastric contents in obese patients. Rev Bras Anestesiol 60: 98-103, 2010 7) Shime N, Ono A, Chihara E, et al.: Current practice of preoperative fasting: a nationwide survey in Japanese anesthesia-teaching hospitals. J Anesth 19: 187-192, 2005 14) 谷口英喜，佐々木俊郎，藤田久栄：術前体液管理への経口補水療法の試み．日臨麻会誌 29：815-823，2009 23) Johnson T, Gerson L, Hershcovici T, et al.: Systematic review: the effects of carbonated beverages on gastro-oesophageal reflux disease. Aliment Pharmacol Ther 31: 607-614, 2010 4) Brady M, Kinn S, Stuart P: Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev (4): CD004423, 2003 22) Vist GE, Maughan RJ: The effect of osmolality and carbohydrate content on the rate of gastric emptying of liquids in man. J Physiol 486: 523-531, 1995 9) Cotton P: Fast-track improves CABG outcomes. JAMA 270: 2023, 1993 11) Braga M, Ljungqvist O, Soeters P, et al.: ESPEN Guidelines on Parenteral Nutrition: Surgery. Clin Nutr 28: 378-386, 2009 15) Lobo DN, Bostock KA, Neal KR, et al.: Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 359: 1812-1818, 2002 13) Guenaga KK, Matos D, Wille-Jørgensen P: Mechanical bowel preparation for elective colorectal surgery (Review). Cochrane Database Syst Rev 21: CD001544, 2009 24) Karamanlis A, Chaikomin R, Doran S, et al.: Effects of protein on glycemic and incretin responses and gastric emptying after oral glucose in healthy subjects. Am J Clin Nutr 86: 1364-1368, 2007 10) Oliveira KG, Balsan M, Oliveira Sde S, et al.: Does abbreviation of preoperative fasting to two hours with carbohydrates increase the anesthetic risk? Rev Bras Anestesiol 59: 577-584, 2009 17) Sanders G, Mercer SJ, Saeb-Parsey K, et al.: Randomized clinical trial of intravenous fluid replacement during bowel preparation for surgery. Br J Surg 88: 1363-1365, 2001 18) Taniguchi H, Sasaki T, Fujita H, et al.: Preoperative fluid and electrolyte management with oral rehydration therapy. J Anesth 23: 222-229, 2009 27) Horowitz M, O'Donovan D, Jones KL, et al.: Gastric emptying in diabetes: clinical significance and treatment. Diabet Med 19: 177-194, 2002 8) 谷口英喜，佐々木俊郎，藤田久栄：全身麻酔前の絶飲食．臨麻 34：1397-1406，2010 1) Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al.: Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24: 466-477, 2005 20) O'Donovan D, Feinle-Bisset C, Jones K, et al.: Gastric emptying, Encyclopedia of Gastroenterology. Edited by Johnson LR. Academic Press, San Diego, 2004, 118-124 25) Awad S, Blackshaw PE, Wright JW, et al.: A randomized crossover study of the effects of glutamine and lipid on the gastric emptying time of a preoperative carbohydrate drink. Clin Nutr 30: 165-171, 2011 (Epub 2010 29) Celeb KK, Glass R, Bresee JS, et al.: Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Morb Mortal Wkly Rep 52 (No. RR-16): 1-16, 2003 30) 佐々木俊郎，柴田俊成，谷口英喜ほか：麻酔前投薬廃止と手術室歩行入室の導入およびその効果．臨床外科 58：985-987，2003 2) Kehlet H, Wilmore DW: Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248: 189-198, 2008 21) Costill DL, Saltin B: Factors limiting gastric emptying during rest and exercise. J Appl Physiol 37: 679-683, 1974 |
| References_xml | – reference: 8) 谷口英喜，佐々木俊郎，藤田久栄：全身麻酔前の絶飲食．臨麻 34：1397-1406，2010 – reference: 10) Oliveira KG, Balsan M, Oliveira Sde S, et al.: Does abbreviation of preoperative fasting to two hours with carbohydrates increase the anesthetic risk? Rev Bras Anestesiol 59: 577-584, 2009 – reference: 30) 佐々木俊郎，柴田俊成，谷口英喜ほか：麻酔前投薬廃止と手術室歩行入室の導入およびその効果．臨床外科 58：985-987，2003 – reference: 26) Patrick A, Epstein O: Review article: gastroparesis. Aliment Pharmacol Ther 27: 724-740, 2008 – reference: 6) Mendelson CL: The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 52: 191-205, 1946 – reference: 9) Cotton P: Fast-track improves CABG outcomes. JAMA 270: 2023, 1993 – reference: 13) Guenaga KK, Matos D, Wille-Jørgensen P: Mechanical bowel preparation for elective colorectal surgery (Review). Cochrane Database Syst Rev 21: CD001544, 2009 – reference: 15) Lobo DN, Bostock KA, Neal KR, et al.: Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 359: 1812-1818, 2002 – reference: 17) Sanders G, Mercer SJ, Saeb-Parsey K, et al.: Randomized clinical trial of intravenous fluid replacement during bowel preparation for surgery. Br J Surg 88: 1363-1365, 2001 – reference: 29) Celeb KK, Glass R, Bresee JS, et al.: Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Morb Mortal Wkly Rep 52 (No. RR-16): 1-16, 2003 – reference: 18) Taniguchi H, Sasaki T, Fujita H, et al.: Preoperative fluid and electrolyte management with oral rehydration therapy. J Anesth 23: 222-229, 2009 – reference: 5) Lobo DN, Hendry PO, Rodrigues G, et al.: Gastric emptying of three liquid oral preoperative metabolic preconditioning regimens measured by magnetic resonance imaging in healthy adult volunteers: a randomised double-blind, crossover study. Clin Nutr 28: 636-641, 2009 – reference: 23) Johnson T, Gerson L, Hershcovici T, et al.: Systematic review: the effects of carbonated beverages on gastro-oesophageal reflux disease. Aliment Pharmacol Ther 31: 607-614, 2010 – reference: 3) Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology 106: 843-863, 2007 – reference: 11) Braga M, Ljungqvist O, Soeters P, et al.: ESPEN Guidelines on Parenteral Nutrition: Surgery. Clin Nutr 28: 378-386, 2009 – reference: 12) Slim K, Vicaut E, Panis Y, et al.: Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 91: 1125-1130, 2004 – reference: 4) Brady M, Kinn S, Stuart P: Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev (4): CD004423, 2003 – reference: 14) 谷口英喜，佐々木俊郎，藤田久栄：術前体液管理への経口補水療法の試み．日臨麻会誌 29：815-823，2009 – reference: 16) Lobo DN, Macafee DA, Allison SP: How perioperative fluid balance influences postoperative outcomes. Best Pract Res Clin Anaesthesiol 20: 439-455, 2006 – reference: 22) Vist GE, Maughan RJ: The effect of osmolality and carbohydrate content on the rate of gastric emptying of liquids in man. J Physiol 486: 523-531, 1995 – reference: 20) O'Donovan D, Feinle-Bisset C, Jones K, et al.: Gastric emptying, Encyclopedia of Gastroenterology. Edited by Johnson LR. Academic Press, San Diego, 2004, 118-124 – reference: 1) Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al.: Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24: 466-477, 2005 – reference: 27) Horowitz M, O'Donovan D, Jones KL, et al.: Gastric emptying in diabetes: clinical significance and treatment. Diabet Med 19: 177-194, 2002 – reference: 2) Kehlet H, Wilmore DW: Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248: 189-198, 2008 – reference: 25) Awad S, Blackshaw PE, Wright JW, et al.: A randomized crossover study of the effects of glutamine and lipid on the gastric emptying time of a preoperative carbohydrate drink. Clin Nutr 30: 165-171, 2011 (Epub 2010) – reference: 24) Karamanlis A, Chaikomin R, Doran S, et al.: Effects of protein on glycemic and incretin responses and gastric emptying after oral glucose in healthy subjects. Am J Clin Nutr 86: 1364-1368, 2007 – reference: 28) Reis Lde A, Reis GF, Oliveira MR: The airways and gastric contents in obese patients. Rev Bras Anestesiol 60: 98-103, 2010 – reference: 7) Shime N, Ono A, Chihara E, et al.: Current practice of preoperative fasting: a nationwide survey in Japanese anesthesia-teaching hospitals. J Anesth 19: 187-192, 2005 – reference: 21) Costill DL, Saltin B: Factors limiting gastric emptying during rest and exercise. J Appl Physiol 37: 679-683, 1974 – reference: 19) Meyer JH, Elashoff JD, Lake R: Gastric emptying of indigestible versus digestible oils and solid fats in normal humans. Dig Dis Sci 44: 1076-1082, 1999 |
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| Snippet | ... [要旨] 米国やEU加盟諸国と同様に, わが国でも術前における体液管理は患者および医療従事者への負担を考慮し, 今後は, 経口的な補水療法へ代わると考える. その際に, 麻酔科医は術前飲食に関する科学的根拠を持ち, 飲料を摂取させる目的を明確に示して, 麻酔科医自らが各施設で使用していく飲料を選択すべきと考える.... |
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| SubjectTerms | Anesthesiologists Evidence Fluid and electrolyte management Oral rehydration therapy Preoperative 体液管理 科学的根拠 経口補水療法 術前飲食 麻酔科医 |
| Title | 術前飲食のevidence─麻酔科医にとっての安全を求めて |
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