Preoperative patient preparation for enhanced recovery after surgery

Abstract

Enhanced recovery after surgery begins before the onset of surgery with detailed and structured preparation of the patient for the surgery they are about to go through. Detailed information to the patient and their kin at a separate occasion in advance of the admission is an important beginning. This ensures that the patient knows what they can do to enhance recovery and what to expect postoperatively including when to go home. Avoiding bowel preparation as a routine avoids unnecessary fasting and fluid derangements before the onset of surgery. Instead of the traditional overnight fasting routine that has no scientific support, modern fasting guidelines should be applied. In these, patients are recommended to take clear fluids ad libitum up until 2 hours before anesthesia. A further improved preparation can be achieved by having the patient take a carbohydrate‐rich clear drink 2 hours before anesthesia. This changes the overnight fasted state of metabolism into a fed state, improves well‐being perioperatively, and markedly reduces the metabolic derangement and the risk for hyperglycemia in the postoperative phase.