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Surgery Hydration Rules Updated

Woman holding glass of water since hydration rules before surgery were updated.
How a Hurricane Changed Fasting Rules for Plastic Surgery

Many of us have been told: “Do not drink or eat anything after midnight” the night before surgery.  Is that still correct?  If not, how did it change?

Hurricane Helene’s Unexpected Impact

In late September 2024, Hurricane Helene became the strongest hurricane on record to strike western Florida.  As Hurricane Helene traveled northwards, it brought catastrophic flooding along its way, including western North Carolina.

Marion, North Carolina was home to one of Baxter International’s manufacturing plants.  This factory produced 60% of the United States’ intravenous (IV) fluid. IV fluid is used to provide hydration when a patient cannot drink liquids – such as during surgery.  Hurricane Helene put this Baxter’s IV fluid manufacturing plant offline, drastically reducing the IV fluid supplies to hospitals and medical offices throughout the country.

In addition to surgeries, intravenous fluids are used for treating dehydration, and in the resuscitation of accident victims.  To avoid running out of IV fluids, some hospitals cancelled elective surgeries.  Meanwhile, healthcare providers searched for ways to reduce the use of IV fluids.

The Science Behind Clear Liquids Before Surgery

Before surgery, a patient was often told to “Not drink or eat anything after midnight.”  This is so a patient’s stomach is empty.  An empty stomach makes anesthesia safer on the day of surgery.   A side effect of not drinking was that patients were often dehydrated on the morning of surgery.  Anesthesiologists would treat this dehydration during surgery – with IV fluids!

As it turns out, not drinking anything after midnight was antiquated.  By March of 2017 the American Society of Anesthesiologists had already published a recommendation that most patients could drink clear liquids up to 2 hours before procedures requiring general anesthesia!  Clear liquids include water, fruit juice without pulp, carbonated beverages, clear tea and black coffee (without milk).  Interestingly, recommendations specifically state that alcohol is not considered a clear liquid.

However, organizational inertia is hard to change.  For years, hospitals continued to advise patients to “Not drink or eat anything after midnight.”  Now in the fall of 2024, with shortage of IV fluids, health care providers began to review fasting practices and decided to implement what the American Society of Anesthesiologists had recommended 7 years earlier!

Better Hydration, Better Recovery

The benefit of being able to drink clear liquids up to 2 hours before surgery has been transformative for my patients.  Patients are less dehydrated going into surgery, which I believe improves their recovery.  Furthermore, patients who are scheduled later in the day, being able to drink clear liquids makes waiting for surgery more comfortable.  Fundamentally, being hydrated before surgery makes sense.  You would not want to be dehydrated before starting a workout.  The same logic should work for surgery.

So, if you are contemplating surgery, ask your doctor if your procedure allows you to drink clear liquids up to two hours before surgery.  In addition to conserving IV fluids, it will make the day of surgery easier on you and perhaps improve your recovery.

Dr. Domanski
Curve Accent

ABOUT DR. DOMANSKI

Focusing on natural results, Dr. Domanski believes in helping patients regain control over their bodies.

Dr. Mark Domanski is a Double-Board certified Plastic Surgeon. Dr. Domanski is certified by the American Board of Plastic Surgery and the American Board of Otolaryngology – Head and Neck Surgery.

He has been recognized as a “Top Doctor” by Washingtonian Magazine, Northern Virginia Magazine and DC Modern Luxury magazine. However, Dr. Domanski’s favorite accolade is his Most Compassionate Doctor award by Patient’s Choice.

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