asa npo guidelines 2020 chewing tobacco asa npo guidelines 2020 chewing tobacco

When the relevant data were not reported in the published work, attempts were made to contact the authors. Differences were not detected in preoperative hunger99 (very low strength of evidence), preoperative thirst99,100 (very low strength of evidence), or preoperative nausea99 (very low strength of evidence). Simple carbohydrates included clear fruit juices or water with glucose or fructose added. Pre-operative ranitidine. And I'd probably RSI them anyway. Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery. Exclusion criteria (except to obtain new citations): For the systematic review, potentially relevant clinical studies were identified via electronic and manual searches of the literature. Benefits, Harms, and Strength of Evidence for Protein-containing Clear Liquids versus Fasting, Benefits, Harms, and Strength of Evidence for Protein-containing Clear Liquids versus Noncaloric Clear Liquids. Procedures whereby upper airway protective reflexes are not impaired, Procedures whereby no risk factors for pulmonary aspiration are apparent. Tolerance of, and metabolic effects of, preoperative oral carbohydrate administration in childrena preliminary report. Anesthesiology 2023; 138:132151 doi: https://doi.org/10.1097/ALN.0000000000004381. Preoperative carbohydrate loading in patients undergoing thoracic surgery: A quality-improvement project. Oral carbohydrate administration in patients undergoing cephalomedullary nailing for proximal femur fractures: An analysis of clinical outcomes and patient satisfaction. Gastric fluid pH in patients receiving sodium citrate. The effect of metoclopramide on gastric contents after preoperative ingestion of sodium citrate. chewing tobacco npo guidelines. Carbohydrate-containing liquids may have an impact on blood glucose levels in patients with diabetes, especially patients who skip or reduce their usual hypoglycemics before surgery. This guide was updated in . 1,3 Reproductive and Developmental Risks A comparison of rabeprazole, lansoprazole, and ranitidine for improving preoperative gastric fluid property in adults undergoing elective surgery. Both the consultants and ASA members disagree that histamine-2 receptor antagonists should be routinely administered before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia in patients with no apparent increased risk for pulmonary aspiration. In this respect, the Sub-Group has produced CORESTA Guide No. An updated report by the ASA task force on preoperative fasting and use of pharmacologic agents to reduce the risk of pulmonary aspiration, which was adopted by the ASA in 2016 and published in 2017.1 The 2017 guideline did not address whether one type of clear liquid, such as water or carbohydrate-containing clear liquids (with and without protein), is more beneficial. Gastric emptying of clear liquid drinks assessed with gastric ultrasonography: A blinded, randomized pilot study. I doubt I could have made it even these four days without a IF lead in. A comparative evaluation of cimetidine and sodium citrate to decrease gastric acidity: effectiveness at the time of induction of anaesthesia. Gastrointestinal stimulants may be preoperatively administered to patients at increased risk of pulmonary aspiration. Aspiration can occur during any type of anesthesia, as a result of . Overarching Recommendations for ASCVD Prevention Efforts e601 1. Alcoholic beverages should be avoided within 8 hours of the scheduled arrival time. The effect of preoperative oral carbohydrate or oral rehydration solution on postoperative quality of recovery: A randomized, controlled clinical trial. Comparative trial of the effect of ranitidine and cimetidine on gastric secretion in fasting patients at induction of anaesthesia. appropriate fasting period. 15 to 16, https://links.lww.com/ALN/C935) and thirst2342 compared with fasting patients (moderate strength of evidence). According to the American Lung Association, chewing tobacco contains at least 28 chemicals that can lead to various illnesses, including mouth, esophageal, and pancreatic cancers, gum disease, and tooth decay and loss. Fasting duration is often substantially longer than recommended irrespective of a 1- or 2-h clear liquid fasting policy.107112 Prolonged fasting influences patient-related outcomes (preoperative thirst, hunger, anxiety, nausea and vomiting, pain, and reduced feeling of well-being) and clinical outcomes (dehydration, electrolyte imbalance, and hypotension at induction of general anesthesia).113,114 Due to low-quality evidence, the task force was unable to make a recommendation for reducing the clear liquid fasting duration to 1h in the pediatric population. Effects of preoperative oral carbohydrate therapy on perioperative glucose metabolism during oralmaxillofacial surgery: Randomised clinical trial. A light meal or nonhuman milk may be ingested for up to 6 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia.. A study of preoperative fasting in infants aged less than three months. A Tool to Screen Patients for Obstructive Sleep Apnea, ACE (Anesthesiology Continuing Education), One-hour Clear Liquid Fasting in Pediatric Patients, Appendix: Study and Patient Characteristics, https://doi.org/10.1097/ALN.0000000000004381, https://CRAN.R-project.org/package=netmeta, https://CRAN.R-project.org/package=metasens, https://gdt.gradepro.org/app/handbook/handbook.html, 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting DurationA Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting, 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade, 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway, Add Chewing Gum to 6-Hour Fasting Guidelines. Perioperative glycemic measures among non-fasting gynecologic oncology patients receiving carbohydrate loading in an enhanced recovery after surgery (ERAS) protocol. Simple or complex carbohydratecontaining clear liquids appear to reduce hunger compared with noncaloric clear liquids. In addition, both the consultants and ASA members strongly agree that verification of their compliance with the fasting requirements should be assessed at the time of the procedure. Society for Ambulatory Anesthesia 12th Annual Meeting, Orlando, Florida, 1997. About the Guidelines The Guidelines Committee has established several task forces to elaborate guidelines on the related subject. Attenuation of gastric effects of famotidine by preoperative administration of intravenous fluids. Safe pre-operative fasting times after milk or clear fluid in children. Placebo-controlled RCTs are equivocal regarding the efficacy of glycopyrrolate to reduce gastric volume or acidity (Category A2-E evidence),83,102 and two nonrandomized placebo-controlled comparative studies report equivocal findings the efficacy of atropine on gastric volume and acidity (Category B1-E evidence).103,104. Many types of smokeless tobacco products are used around the world. American Society of Anesthesiologists Committee. The effect of three different ranitidine dosage regimens on reducing gastric acidity and volume in ambulatory surgical patients. asa npo guidelines 2020 chewing tobacco asa npo guidelines 2020 chewing tobacco vo 9 Thng Su, 2022 vo 9 Thng Su, 2022 Population: patients undergoing general anesthesia, regional anesthesia, or procedural sedation for elective procedures, Interventions: drinking carbohydrate-containing clear liquids (simple or complex) until 2h before general anesthesia, regional anesthesia, or procedural sedation for elective procedures; drinking protein-containing clear liquids (all studied included carbohydrates) until 2h before general anesthesia, regional anesthesia, or procedural sedation for elective procedures; gum chewing before surgery/procedure; and a shortened duration for clear liquid fasting in children of 1 h, Comparators: fasting or drinking noncaloric clear liquids (e.g., water, placebo, broth, black tea, black coffee); no gum chewing; and clear liquid fasting duration of 2h in pediatric patients. Aspiration of gastric contents was not evident in the studies. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Association of nausea and length of stay with carbohydrate loading prior to total joint arthroplasty. The mean age of participants was 43.2 yr, and 64% were female. Practice guidelines aim to improve patient care and patient outcomes by providing up-to-date information for patient care. Decision-making is complicated by emerging data suggesting that some of the conditions traditionally considered to have an impact on gastric emptying may have little or no effect on gastric emptying. The body of evidence included 10 studies (7 randomized controlled trials,9297,187 1 crossover study,98 1 single-arm study,188 and 1 case series189) comparing chewing gum (sugar-free or sugared) with fasting, water, or lollipops. This was my first step in dramatically reducing my alcohol intake. Randomized clinical trial to compare the effects of preoperative oral carbohydrate loading. Anesthesia care during procedures refers to general anesthesia, regional anesthesia, or procedural sedation and analgesia. The complex carbohydrate used in the carbohydrate-loading interventions was maltodextrin. Supplemental tables 17 through 19 (https://links.lww.com/ALN/C934) detail the strength-of-evidence ratings. Accepted for publication August 30, 2022. When significant heterogeneity was found among the studies (P< 0.01), DerSimonian-Laird random-effects odds ratios were obtained. CINeMA: An approach for assessing confidence in the results of a network meta-analysis. Preoperative fasting abbreviation and its effects on postoperative nausea and vomiting incidence in gynecological surgery patients. Clear fluids are: Do not swallow gum or hard candy. Insulin resistance after cardiopulmonary bypass in the elderly patient. Literature citations are obtained from healthcare databases, direct internet searches, Task Force members, liaisons with other organizations, and from manual searches of references located in reviewed articles. Benefits of fasting abbreviation with carbohydrates and omega-3 infusion during CABG: A double-blind controlled randomized trial. The effects of intravenous cimetidine and metoclopramide on gastric pH and volume in outpatients. Fourth, opinions about the guideline recommendations were solicited from a random sample of active members of the ASA. For these updated guidelines, systematically-reviewed studies used in the development of the previous update were combined with a systematic review of studies published subsequent to ASA approval in 2010. The body of evidence was first described according to study characteristics and treatment arms. A meta-analysis of three trials found a difference of 2.5ml (95% CI, 8.6 to 3.7) in residual gastric volume for protein-containing clear liquids versus fasting.49,68,91. Decreased risk of dehydration or hypoglycemia from prolonged fasting. mjk funeral home obituaries; san jose state university graduate programs deadlines Men umschalten. Level 1: The literature contains observational comparisons (e.g., cohort, case-control research designs) with comparative statistics between clinical interventions for a specified clinical outcome. The guidelines may not apply to or may need to be modified for patients with coexisting diseases or conditions that can affect gastric emptying or fluid volume (e.g., pregnancy, obesity, diabetes, hiatal hernia, gastroesophageal reflux disease, ileus or bowel obstruction, emergency care, or enteral tube feeding) and patients in whom airway management might be difficult. One randomized controlled trial comparing 2 h fasting with fasting from midnight reported equivocal findings for blood glucose and insulin values (Category A3-E evidence).43. Editorials, letters, and other articles without data were excluded. Oral carbohydrate supplementation reduces preoperative discomfort in laparoscopic cholecystectomy. Oral rehydration with 10% carbohydrate drink for preventing postoperative nausea and vomiting (PONV) after low dose of spinal morphine. Inform patients of fasting requirements and the reasons for them sufficiently in advance of their procedures. Drinking carbohydrate-containing clear liquids resulted in lower hunger ratings than did noncaloric clear liquids (moderate strength of evidence).23,24,26,39,41,7275 Differences were not evident for patient ratings of thirst23,24,26,39,41,72,73,7577 (low strength of evidence) and nausea23,24,26,73 (low strength of evidence) or in rates of preoperative thirst78 and nausea23,24,26,39,73,79 (both very low strength of evidence). Comparators of interest include, Carbohydrate- and protein-containing clear liquids alone and in combination. This current update consists of a literature evaluation and an update of the evidence-based guideline nomenclature. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies. Anesthesiology, V 126 No 3 376 March 2017: Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures An Updated Report by the American Society of Anesthesiologists Task One study included younger children (mean age, 3 yr), 2 included children with mean or median age of 5 yr, and the remaining studies reported median ages ranging from 7 to 11 yr. Five studies were conducted in surgical settings, and 4 were nonsurgical. (Chair), Chicago, Illinois; Madhulika Agarkar, M.P.H., Schaumburg, Illinois; Richard T. Connis, Ph.D., Woodinville, Washington; Charles J. Cot, M.D., Boston, Massachusetts; David G. Nickinovich, Ph.D., Bellevue, Washington; and Mark A. Warner, M.D., Rochester, Minnesota. The task force reaffirms the 2017 recommendations for clear liquids until 2h preoperatively.1 Simple or complex carbohydratecontaining clear liquids appear to reduce patient hunger when compared with noncaloric clear liquids. To evaluate potential publishing bias, a fail-safe n value was calculated. Preoperative oral carbohydrate reduces postoperative insulin resistance by activating amp-activated protein kinase after colorectal surgery. Comparison of different non-pharmacological preoperative preparations on gastric fluid volume and acidity: A randomized controlled trial. The term gastroesophageal reflux disease refers to positional reflux and its consequent symptomology, rather than food intolerances (e.g., tomatoes do not agree with me). The history, examination, and interview should include assessment of ASA physical status, age, sex, type of surgery, and potential for difficult airway management as well as consideration of gastroesophageal reflux disease,* dysphagia symptoms, other gastrointestinal motility and metabolic disorders (e.g., diabetes mellitus) that may increase the risk of regurgitation and pulmonary aspiration. For the previous update, an additional survey was sent to the consultants asking them to indicate which, if any, of the evidence linkages would change their clinical practices if the guidelines were instituted. About Us; Staff; Camps; Scuba. Investigation of preoperative fasting times in children. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. A single randomized controlled trial reported higher satisfaction in parents of children with a 1-h clear liquid fast compared with parents of children with a 2-h clear liquid fast99 (very low strength of evidence). Second, original published research studies from peer-reviewed journals relevant to preoperative fasting and pulmonary aspiration were reviewed and evaluated. GRADE guidelines: 2. Advise tobacco users to quit. Comparative trial of the effect of ranitidine and cimetidine on gastric secretion in fasting patients at induction of anaesthesia. Conflicts were resolved by consensus. asa npo guidelines 2020 chewing tobacco. Do not routinely administer preoperative gastrointestinal stimulants for the purpose of reducing the risk of pulmonary aspiration in patients with no apparent increased risk for pulmonary aspiration. A comparison of the volume and pH of gastric contents of obese and lean surgical patients. GRADE guidelines: 14. The evidence in adults comparing noncaloric clear liquids with those containing protein was limited, with one to two studies reporting each outcome of interest (table 5). The updated searches covered a 6.5-yr period from January 1, 2010, through May 31, 2016. A Comparative efficacy of conventional H2 receptor blocker ranitidine and newer proton pump inhibitors omeprazole, pantoprazole and esomeprazole for improvement of gastric fluid property in adults undergoing elective surgery. Benefits of oral administration of an electrolyte solution interrupting a prolonged preoperatory fasting period in pediatric patients. Safe intake of an oral supplement containing carbohydrates and whey protein shortly before sedation to gastroscopy; a double blind, randomized trial. These practice guidelines are a modular update of the Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures. The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration. Cimetidine in the prevention of acid aspiration during anesthesia. Do not routinely administer preoperative antacids for the purpose of reducing the risk of pulmonary aspiration in patients with no apparent increased risk for pulmonary aspiration. Previous ASA guidelines recommend that clear liquids such as water, black coffee, black tea, and juice without pulp are safe to drink until 2 h before general anesthesia, regional anesthesia, or procedural sedation for elective procedures. Ninety-six percent of the respondents indicated that the guidelines would have no effect on the amount of time spent on a typical case. Reduction of the risk of acid pulmonary aspiration in anaesthetized patients after cimetidine premedication. The characteristics of randomized trials supporting recommendations for adult surgical patients included a median of 46 participants (range, 20 to 150). Although the task force does not recommend delaying surgery in healthy adults who have chewed gum during the fasting period, we urge clinicians to confirm the gum has been removed before anesthetic administration. They also strongly agree that patients should be informed of fasting requirements and the reasons for them sufficiently in advance of their procedures. Aspiration,49,53,55,57,80 regurgitation,55,68 and preoperative vomiting85 were not reported in any studies comparing protein-containing clear liquids with noncaloric clear liquids. Preoperative nil per os (NPO) guidelines have been in existence since the recognition of the risk of perioperative aspiration. Prevention of perioperative pulmonary aspiration is part of the process of preoperative evaluation and preparation of the patient. chewing tobacco npo guidelines. Ultrasound assessment of gastric volume in children after drinking carbohydrate-containing fluids. Evaluation of effects of a preoperative 2-hour fast with glutamine and carbohydrate rich drink on insulin resistance in maxillofacial surgery. Effects of preoperative oral carbohydrate on cirrhotic patients under endoscopic therapy with anesthesia: A randomized controlled trial. The purpose of this modular update is to evaluate the current evidence on preoperative fasting, focusing on these interventions. Medications that block gastric acid secretion may be preoperatively administered to patients at increased risk of pulmonary aspiration. Evaluation of gastric residual volume in fasting diabetic patients using gastric ultrasound. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic No aspiration after carbohydrate-containing clear or noncaloric clear liquids was reported in 17 randomized controlled trials.23,24,26,39,55,57,59,63,74,75,77,78,8084 (strength of evidence not rated due to lack of events). The effects of chewing gum on gastric content prior to induction of general anesthesia. Premedication with cimetidine and metoclopramide. 1 Clear liquids include water, tea, black coffee, pulp-free juice, and carbohydrate-rich drinks. Do preoperative oral carbohydrates improve postoperative outcomes in patients undergoing coronary artery bypass grafts? The Cochrane Collaborations tool for assessing risk of bias in randomised trials. Procedures in which upper airway protective reflexes may be impaired. The effect of a new preoperative fasting regime on the subjective perception, postoperative recovery, postoperative complications, and satisfaction in pediatric patients. Both the systematic literature review and opinion data are based on evidence linkages, or statements regarding potential relationships between preoperative fasting interventions and pulmonary aspiration or associated complications. should I observe the same fasting intervals? Technical Guideline for Sample Handling of Smokeless Tobacco and Smokeless Tobacco Products Status: Valid Note: This document will be periodically reviewed by CORESTA Document history: Date of Review Information September 2019 Version 1 May 2020 Version 2 - Major update and total revision. 8,827. No differences in the occurrence of regurgitation were detected. Both simple and complex carbohydratecontaining clear liquids were slightly more advantageous compared with noncaloric clear liquids in patient satisfaction. The goal for preoperative fasting is to reduce the risk of aspiration of gastric contents. Evaluation of preoperative oral carbohydrate administration on insulin resistance in off-pump coronary artery bypass patients: A randomised trial. All studied protein-containing clear liquids also contained carbohydrates. Search terms consisted of the interventions indicated above guided by the appropriate inclusion/exclusion criteria as stated in the Focus section of these updated guidelines. Outcomes assessed were limited to gastric volume, gastric acidity, nausea, and vomiting (table 2). Cimetidine as a single oral dose for prophylaxis against Mendelsons syndrome. The ASA members disagree and the consultants strongly disagree that preoperative anticholinergics should be routinely administered before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia to decrease the risk of pulmonary aspiration. Submitted for publication October 26, 2016. Effects of preoperative carbohydrate drinks on postoperative outcome after colorectal surgery. Aspiration was not reported (strength of evidence not rated due to lack of events). The consultants and ASA members both disagree that preoperative antiemetics should be routinely administered before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia in patients with no apparent increased risk for pulmonary aspiration. Anesthesiology 2017; 126:376393 doi: https://doi.org/10.1097/ALN.0000000000001452. The incidence and outcome of perioperative pulmonary aspiration in a university hospital: A 4-year retrospective analysis. You will also find usable tools to guide your practice and help you integrate tobacco treatment into routine clinical care. Both the consultants and ASA members agree that for neonates and infants, fasting from the intake of infant formula for 6 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. Safety and benefit of pre-operative oral carbohydrate in infants: A multi-center study in China. See the Tobacco and Nicotine CessationGuideline for additional information. Discordant results for residual gastric volume were reported in two trials99,100 randomizing patients to 1- and 2-h fasting. Complications of aspiration include, but are not limited to, aspiration pneumonia, respiratory compromise, and related morbidities. army pistol qualification scores; steamboat springs music festival 2022. thai market hollywood blvd; dad when are you coming back with the milk it's been 4 months text Residual gastric volume evaluation with ultrasonography after ingestion of carbohydrate- or carbohydrate plus glutamine-enriched beverages: A randomized, crossover clinical trial with healthy volunteers. Gastric emptying after overnight fasting and clear fluid intake: A prospective investigation using serial magnetic resonance imaging in healthy children. Free dissociable IGF-I: Association with changes in igfbp-3 proteolysis and insulin sensitivity after surgery. chewing tobacco npo guidelines Statement on Surgical Attire (Amended October 26, 2022) Statement on the Aging Anesthesiologist. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. That's a GOOD thing. A carbohydrate-rich drink shortly before surgery affected IGF-I bioavailability after a total hip replacement. The anesthesiologist and patient representative task force members rated the importance of each outcome for decision-making on a scale of 1 to 9 (1 to 3, of limited importance; 4 to 6, important; 7 to 9, critical).8 The evidence synthesis focused on the outcomes rated important or critical. Both the consultants and ASA members strongly agree that fasting from the intake of a meal that includes fried or fatty foods for 8 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. asa npo guidelines 2020 chewing tobaccohershey high school homecoming 2019. They also may serve as a resource for other health care professionals who advise or care for patients who receive anesthesia care during procedures. Clear liquids containing less than 10 gm/ml carbohydrate were not considered carbohydrate-containing. buick lacrosse for sale under $10,000. All meta-analyses are conducted by the ASA methodology group. Updated by the American Society of Anesthesiologists Task Force on Preoperative Fasting. Third, expert consultants were asked to: (1) participate in opinion surveys on the effectiveness of various preoperative fasting strategies and pharmacologic agents and (2) review and comment on a draft of the guidelines developed by the Task Force. Anesthesiology 2011; 114:495511. The guideline topics were approved by the Guidelines Committee and the ESAIC Board after a consultation process within the subcommittees of the ESAIC Scientific Committee. A carbohydrate-rich beverage prior to surgery prevents surgery-induced immunodepression: A randomized, controlled, clinical trial. The ASA members disagree and the consultants strongly disagree that preoperative multiple agents should be routinely administered before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia in patients with no apparent risk for pulmonary aspiration. Reduction of complications associated with pulmonary aspiration. Identification of patients at increased risk of pulmonary aspiration (e.g., obesity, diabetes, smoking history): Medical records review (focused history). Rigorous comparisons for equivalence or superiority between 1-h versus 2-h fasting durations in pediatric patients are needed. Preoperative fasting abbreviation (enhanced recovery after surgery protocol) and effects on the metabolism of patients undergoing gynecological surgeries under spinal anesthesia: A randomized clinical trial. Effects of preoperative oral carbohydrates and trace elements on perioperative nutritional status in elective surgery patients. Postoperative inflammation and insulin resistance in relation to body composition, adiposity and carbohydrate treatment: A randomised controlled study. The consultants agree and the ASA members strongly agree that for children and adults, fasting from the intake of nonhuman milk for 6 or more hours before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia should be maintained. In summary, the evidence showed that for patients with low risk of aspiration, carbohydrate-containing clear liquids until 2h preoperatively was superior to absolute fasting with respect to beneficial outcomes, without evidence of increased risks. Clear liquids may be ingested for up to 2 h before procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia. Effects of a carbohydrate-, glutamine-, and antioxidant-enriched oral nutrition supplement on major surgery-induced insulin resistance: A randomized pilot study. Lansoprazole in the prophylaxis of acid aspiration during elective surgery.