The Impact of Variations in Fasting Duration on Hemodynamic Status and Blood Sugar Levels in Electional Surgery Patients
DOI:
https://doi.org/10.37287/ijghr.v8i2.669Keywords:
blood sugar levels, elective surgery, fasting variations, hemodynamic status, management, perioperativeAbstract
Preoperative fasting is a standard applied in surgical services to prevent aspiration, but in hospital practice, fasting often occurs that exceeds the recommendations of the American Society of Anesthesiologists (ASA) which recommends a minimum fast of 6-8 hours, the negative impact of extended fasting will affect the hemodynamic and metabolic status of patients. This study aims to analyze the impact of variations in fasting duration with hemodynamic status and blood sugar levels in patients. This study used a quantitative design with a cross-sectional approach with a sample of 252 elective surgical patients collected by purposive sampling. Data collected included demographic characteristics, ASA physical status I-II, fasting duration, and preoperative clinical parameters. with inclusion criteria: respondents aged 18-55 years, ASA physical status I-II, undergoing elective surgery while exclusion criteria were patients with metabolic disorders such as diabetes mellitus or unstable cardiovascular disorders and cytotoxic patients. Data were collected using observation sheets related to demographics, physical status, type of surgery, last meal, and post-operative complaints, as well as a Non-Invasive Blood Pressure Monitor (NIBP) to measure hemodynamics, a pulse oximeter for oxygen saturation, and a glucometer for glucose levels. The results of the one way anova test showed that variations in fasting duration did not affect hemodynamics (p > 0.05), but did affect blood sugar levels where the value (p < 0.05). It was found that these findings confirm that pre-operative fasting beyond the recommendation can affect the patient's metabolic status, so that fasting duration management according to ASA standards is important to maintain the patient's metabolic and physiological stability.
References
Akbuga, G. A., & Başer, M. (2021). Effect of preoperative oral liquid carbohydrate intake on blood glucose, fasting-thirst, and fatigue levels: a randomized controlled study. Brazilian Journal of Anesthesiology (English Edition), 71(3), 247–253. https://doi.org/10.1016/j.bjane.2021.02.053
Alexandre. (2024). Hemodynamic Monitoring and Fluid Therapy during Surgery. In Hemodynamic Monitoring and Fluid Therapy during Surgery. Cambridge University Press. https://doi.org/10.1017/9781009226899
Anas, M., Jehad, A., Akmal shah, U., Gul, H., Ali, M., Salma, & Aqsa. (2024a). Exploring the Preoperative Fasting and Perioperative Hemodynamic variability in Elective Surgery Under General Anesthesia. National Journal of Life and Health Sciences, 3(1), 47–52. https://doi.org/10.62746/njlhs.v3n1.1
ASA. (2019). 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. Anesthesiology, 126(3), 376–393. https://doi.org/10.1097/ALN.0000000000001452
Assen, H. E., Hassen, A. M., Abate, A., & Liyew, B. (2021). Preoperative Fasting Time and Its Association with Hypoglycemia during Anesthesia in Pediatric Patients Undergoing Elective Procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. BioMed Research International, 2021. https://doi.org/10.1155/2021/9166603
Bilgili, B., & Umuroglu, T. (2025). The Impact of Preoperative Duration of Fasting on the Intravascular Volume Status of Children Older than 5 Years of Age: A Prospective, Observational Study. Turkish Journal of Anaesthesiology and Reanimation. https://doi.org/10.4274/tjar.2025.251934
Coutinho, R. B., Ferreira Peres, W. A., & de Paula, T. P. (2024). Association between preoperative fasting time and clinical outcomes in surgical patients in a private general hospital. Acta Cirurgica Brasileira, 39. https://doi.org/10.1590/acb394524
Daniel, A. (2022). Perioperative glucose control in neurosurgical patients. Anesthesiology Research and Practice. https://doi.org/10.1155/2012/690362
Das, U. N. (2019). Renin–angiotensin–aldosterone system in insulin resistance and metabolic syndrome. Journal of Translational Internal Medicine, 4(2), 66–72. https://doi.org/10.1515/jtim-2016-0022
Delalio, L. J., Sved, A. F., & Stocker, S. D. (2020). Sympathetic Nervous System Contributions to Hypertension: Updates and Therapeutic Relevance. In Canadian Journal of Cardiology (Vol. 36, Issue 5, pp. 712–720). Elsevier Inc. https://doi.org/10.1016/j.cjca.2020.03.003
Demirci, E., Çalapkorur, B., Celik, O., Koçer, D., Demirelli, S., & Şimsek, Z. (2023). Improvement in Blood Pressure After Intermittent Fasting in Hipertension: Could Renin-Angiotensin System and Autonomic Nervous System Have a Role? Arquivos Brasileiros de Cardiologia, 120(5). https://doi.org/10.36660/abc.20220756
Dennhardt, N., Beck, C., Huber, D., Nickel, K., Sander, B., Witt, L.-H., Boethig, D., & Sümpelmann, R. (2015). Impact of preoperative fasting times on blood glucose concentration, ketone bodies and acid–base balance in children younger than 36 months. European Journal of Anaesthesiology, 32(12), 857–861. https://doi.org/10.1097/EJA.0000000000000330
Elfira, Y., Irwadi, I., & Fatimah, F. (2025). Preoperative Fasting and Blood Sugar Highlights Emergency Complications in General Anesthesia Patients. Indonesian Journal of Global Health Research, 7(4), 1037–1044. https://doi.org/10.37287/ijghr.v7i4.6556
Elsharkawy, A. M., Daliya, P., Lewis-Lloyd, C., Adiamah, A., Malcolm, F. L., Boyd-Carson, H., Couch, D., Herrod, P. J. J., Hossain, T., Couch, J., Sarmah, P. B., Sian, T. S., Lobo, D. N., Anjum, S., Aghanenu, O., Barlow, S., Chukwuemeka, W., Daud, H., Green, R., … Wolff, J. (2021). Fasting and surgery timing (FaST) audit. Clinical Nutrition, 40(3), 1405–1412. https://doi.org/10.1016/j.clnu.2020.08.033
Felicita Dausawati, A., Tavianto, D., & Kadarsah, R. K. (2019). Hubungan antara Lama Puasa Preanestesi dan Kadar Gula Darah Saat Induksi pada Pasien Pediatrik yang Menjalani Operasi Elektif. In JAP (Vol. 3, Issue 3).
Fenneni, M. A., Latiri, I., Aloui, A., Rouatbi, S., Chamari, K., & Saad, H. Ben. (2019). Effects of Ramadan intermittent fasting on North African children’s heart rate & oxy-haemoglobin saturation at rest & during sub-maximal exercise. Cardiovascular Journal of Africa, 28(3), 176–181. https://doi.org/10.5830/CVJA-2016-078
Frykholm, P., Disma, N., Andersson, H., Beck, C., Bouvet, L., Cercueil, E., Elliott, E., Hofmann, J., Isserman, R., Klaucane, A., Kuhn, F., De Queiroz Siqueira, M., Rosen, D., Rudolph, D., Schmidt, A. R., Schmitz, A., Stocki, D., Sümpelmann, R., Stricker, P. A., … Afshari, A. (2022). Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care. European Journal of Anaesthesiology, 39(1), 4–25. https://doi.org/10.1097/EJA.0000000000001599
Hajian, P., Shabani, M., Khanlarzadeh, E., & Nikooseresht, M. (2020). The Impact of Preoperative Fasting Duration on Blood Glucose and Hemodynamics in Children. Journal of Diabetes Research, 2020. https://doi.org/10.1155/2020/6725152
Hwang, B. Y., Mampre, D., Boesch, J. R., Huang, J., & Anderson, W. S. (2021). Total Fasting and Dehydration in the Operating Room: How Can Surgeons Survive and Thrive? Journal of Surgical Education, 78(4), 1295–1304. https://doi.org/10.1016/j.jsurg.2020.12.018
John E. Hall. (2020). Guyton and Hall Textbook of Medical Physiology (11 th). Saunders Elsevier. http://avaxho.me/blogs/ChrisRedfield
Johnston, L. E., Kirby, J. L., Downs, E. A., LaPar, D. J., Ghanta, R. K., Ailawadi, G., Kozower, B. D., Kron, I. L., McCall, A. L., & Isbell, J. M. (2019). Postoperative Hypoglycemia Is Associated With Worse Outcomes After Cardiac Operations. Annals of Thoracic Surgery, 103(2), 526–532. https://doi.org/10.1016/j.athoracsur.2016.05.121
Joshi, G. P., Abdelmalak, B. B., Weigel, W. A., Harbell, M. W., Kuo, C. I., Soriano, S. G., Stricker, P. A., Tipton, T., Grant, M. D., Marbella, A. M., Agarkar, M., Blanck, J. F., & Domino, K. B. (2023). 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration - A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting∗. Anesthesiology, 138(2), 132–151. https://doi.org/10.1097/ALN.0000000000004381
Komurcu, O., Genc, C., Kurt, B. C., Demir, O., Akbaş, A., Akyurt, D., Kuşderci, H. S., Tulgar, S., & Süren, M. (2024). Preoperative evaluation: Impact on early perioperative hemodynamic and respiratory complications. BMC Anesthesiology, 24(1). https://doi.org/10.1186/s12871-024-02821-1
Lee, D., Kim, S. J., & Chang, W. B. (2025). The safety and effect of preoperative reduced fasting time by oral clear liquid administration in adult surgery patients: a randomized controlled trial. Annals of Surgical Treatment and Research, 109(1), 1–6. https://doi.org/10.4174/astr.2025.109.1.1
Li, Y., Su, D., Sun, Y., Hu, Z., Wei, Z., & Jia, J. (2019). Influence of different preoperative fasting times on women and neonates in cesarean section: A retrospective analysis. BMC Pregnancy and Childbirth, 19(1). https://doi.org/10.1186/s12884-019-2254-2
Lin, M. W., Chen, C. I., Cheng, T. T., Huang, C. C., Tsai, J. W., Feng, G. M., Hwang, T. Z., & Lam, C. F. (2021). Prolonged preoperative fasting induces postoperative insulin resistance by er-stress mediated glut4 down-regulation in skeletal muscles. International Journal of Medical Sciences, 18(5), 1189–1197. https://doi.org/10.7150/ijms.52701
Mollura, D. J., Lungren, M. P., Evans, M. R. B., Dillane, D., & Finegan, B. A. (2021). Preoperative Assessment (D. Dillane & B. A. Finegan, Eds.). Springer International Publishing. https://doi.org/10.1007/978-3-030-58842-7
Muller, L., Briere, M., Bastide, S., Roger, C., Zoric, L., Seni, G., De La Coussaye, J. E., Ripart, J., & Lefrant, J. Y. (2019). Preoperative fasting does not affect haemodynamic status: A prospective, non-inferiority, echocardiography study. British Journal of Anaesthesia, 112(5), 835–841. https://doi.org/10.1093/bja/aet478
Najm, Dr. E. S., Fadhil, Dr. A. A., & Shibli Younis, Dr. R. M. (2023). The Effect of Fluid Preloading on the Incidence of Hypotension During Spinal Anesthesia. Journal of Prevention, Diagnosis and Management of Human Diseases, 34, 26–35. https://doi.org/10.55529/jpdmhd.34.26.35
Paluchamy, T. (2020). Hypoglycemia: Essential Clinical Guidelines. In Blood Glucose Levels. IntechOpen. https://doi.org/10.5772/intechopen.86994
Papagiannopoulos, I. A., Sideris, V. I., Boschmann, M., Koutsoni, O. S., & Dotsika, E. N. (2019). Anthropometric, hemodynamic, metabolic, and renal responses during 5 days of food and water deprivation. Forschende Komplementarmedizin, 20(6), 427–433. https://doi.org/10.1159/000357718
Povoa, R. (2023). Intermittent Fasting and Blood Pressure Reduction: Related Mechanisms. In Arquivos Brasileiros de Cardiologia (Vol. 120, Issue 5). Sociedade Brasileira de Cardiologia. https://doi.org/10.36660/abc.20230265
Ruggeberg, A., Meybohm, P., & Nickel, E. A. (2024). Preoperative fasting and the risk of pulmonary aspiration—a narrative review of historical concepts, physiological effects, and new perspectives. In BJA Open (Vol. 10). Elsevier B.V. https://doi.org/10.1016/j.bjao.2024.100282
Scott, M. J., Turan, A., Angus, S., Cannesson, M., Cole, D. J., Culley, D., Duggan, E., Dutton, R. P., Feldman, J., Grocott, M. P. W., Huet, O., Huffenberger, A., Janda, A. M., Khanna, A. K., Ko, C., Matadial, C., McEvoy, M. D., Shah, N., Szokol, J., & Sun, L. Y. (2024a). Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation. Anesthesia and Analgesia, 138(4), 713–724. https://doi.org/10.1213/ANE.0000000000006789
Sreedharan, R., Khanna, S., & Shaw, A. (2023). Perioperative glycemic management in adults presenting for elective cardiac and non-cardiac surgery. Perioperative Medicine, 12(1). https://doi.org/10.1186/s13741-023-00302-6
Su, Y., Liu, K., Zheng, J.-L., Li, X., Zhu, D.-M., Zhang, Y., Zhang, Y.-J., Wang, C.-S., SHI, T.-T., Luo, Z., & Tu, G.-W. (2020). Hemodynamic monitoring in patients with venoarterial extracorporeal membrane oxygenation. Annals of Translational Medicine, 8(12), 792–792. https://doi.org/10.21037/atm.2020.03.186
Togo, H. Y. A., & Lopes, E. C. (2020). Preoperative fasting reduction in burned patients: A systematic review. In Burns Open (Vol. 4, Issue 4, pp. 176–182). Elsevier B.V. https://doi.org/10.1016/j.burnso.2020.06.004
Triebel, H., & Castrop, H. (2024). The renin angiotensin aldosterone system. Pflugers Archiv European Journal of Physiology, 476(5), 705–713. https://doi.org/10.1007/s00424-024-02908-1
Tsukamoto, M., Hitosugi, T., & Yokoyama, T. (2021). Influence of fasting duration on body fluid and hemodynamics. Anesthesia Progress, 64(4), 226–229. https://doi.org/10.2344/anpr-65-01-01
Vishak, M., Gayathri, B., Chandrasekhar, G., & Ramani, S. (2023). Randomized Controlled Trial Comparing the Effects of Preoperative Carbohydrate and Non-carbohydrate Loading on Gastric Emptying in Diabetic and Non-diabetic Patients Posted for Elective Surgery. Cureus. https://doi.org/10.7759/cureus.49213
Wang, M., Wang, Q., & Whim, M. D. (2019). Fasting induces a form of autonomic synaptic plasticity that prevents hypoglycemia. Proceedings of the National Academy of Sciences of the United States of America, 113(21), E3029–E3038. https://doi.org/10.1073/pnas.1517275113
Wang, Y., & Wu, R. (2022). The Effect of Fasting on Human Metabolism and Psychological Health. In Disease Markers (Vol. 2022). Hindawi Limited. https://doi.org/10.1155/2022/5653739
Warner, M. A., Caplan, R. A., Epstein, B. S., Gibbs, C. P., Keller, C. E., Leak, J. A., Maltby, R., Nickinovich, D. G., Schreiner, M. S., & Weinlander, C. M. (2019). 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. Survey of Anesthesiology, 44(1), 47–48. https://doi.org/10.1097/00132586-200002000-00048
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