Pharmacology

ClearFast

The “NPO guidelines” (ie, 8 hours for full meals, 6 hours for light meals, 2 hours for clear liquids) have varying degrees of “evidence”, but for the most part, patients are told to “eat or drink nothing after midnight.” In my opinion, they are just that – GUIDELINES. I think we cause a lot more harm by being ultra-conservative and starving so many of our patients! What if your case isn’t till 3 PM the next day? Won’t that amount of NPO time affect hydration? Or stress? Or glucose metabolism? Or patient satisfaction in general (*cough-Press-Ganey-scores-cough*)?

ClearFast is a complex carbohydrate rich solution becoming widely incorporated into enhanced recovery after surgery (ERAS) protocols around the country. Patients receive ~24 ounces of this fluid which also contains electrolytes, vitamins, and minerals to help facilitate healing, nourishment, immunity, and tissue function. More conventional drinks (ie, water, Gatorade, etc.) may help with a patient’s hydration status but don’t really help mitigate insulin resistance by putting the body into an anabolic state of nourishment pre-operatively. These physiologic alterations should help promote post-operative recovery!

I recommend that my patients on an ERAS pathway drink two bottles before coming to the hospital on the day of their surgery. I hope we can more routinely provide carb-rich drinks 2-3 hours before surgery along with pre-operative oral analgesic medications (Tylenol, Celebrex, Lyrica, etc.). Unlike most of the medications I write about, ANYONE can buy ClearFast (after all, it’s just a nutrition drink). It’s $13 for two bottles on Amazon.

Drop me a comment below with questions! 🙂

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Rishi

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