The immediate preoperative periodCu

The immediate preoperative periodCurrent fasting guidelines have cut the hours of fasting because not only are long fasting periods a cause for anxiety and discomfort to the patients, it also increases the stress response and worsens catabolism. Six hours for solids and 2 hours for clear liquids work very well for ER and such patients remain euvolemic and well hydrated, with less requirement for intravenous fluids. Oral carbohydrate pre-loading is done with a clear carbohydrate beverage (100 mg of carbohydrate) on the night before the surgery and 3 hours prior to surgery. Carbohydrate preloading attenuates the neuroendocrine stress response, catabolism, and insulin resistance and improves well-being. Thromboprophylaxis is recommended for all patients starting with a single dose of enoxaparin 20 mg the night before surgery and continued for the duration of hospitalization. Use of intermittent pneumatic compression device and compression stockings followed by early mobilization is recommended. The risk of bleeding is evaluated and weighed against the risk of venous thromboembolism. Antibiotic prophylaxis is given within 60 minutes of incision to the skin.