In the case of patients undergoing general anesthesia, fasting of 8 hours of solid food, 6 hours of light meals, and 2 hours of clear drink is strictly followed in accordance with the guidelines of the American Society of Anesthesiology to prevent complications such as regurgitation of gastric juice and pulmonary aspiration. Currently, the concept of early recovery after surgery (ERAS) was introduced for early recovery after surgery in various surgical patients. In accordance with this guideline, a clear liquid should be consumed 2 hours before anesthesia, and carbohydrate beverages should be administered during the fasting period. 
Oral carbohydrate loading in the preoperative period minimizes the side effects such as catabolic state and delay in recovery due to excessive fasting can be prevented, and promotes the patient's satisfaction and well-being. Oral carbohydrate loading is recommended to administer 800ml to 400ml of carbohydrate beverages up to 2 hours before surgery as a standard practice. The ERAS Society has suggested that chewing gum during the fasting period before surgery also has a positive effect and can be recommended. Studies have recently been published that chewing gum in the preoperative fasting period does not affect gastric volume and acidity in patients before surgery, lowers patient anxiety, and reduces side effects from fasting. We recently conducted study in the gynecologic patients of our hospital that chewing gum during preoperative period has an significant effect in reducing preoperative anxiety and improving postoperative recovery (SMC 2019-05-168-001). Similar to the previous study results, no adverse events were reported. 
 At present, gynecology department of our hospital decided to apply the ERAS protocol  to patients who are scheduled to undergo surgery at the gynecological cancer center, and accordingly, they will take a carbohydrate drink during the fasting time before surgery. 
 This study is a serial study (SMC 2019-05-168-001) on the anxiety reduction effect of chewing gum within the preoperative fasting time. Patients participating in the altered treatment protocol of  gynecology were set as a control group and the fasting period before surgery. We would like to investigate whether there is an effect of reducing anxiety and discomfort before surgery by additionally performing a sham feeding with chewing gum. In addition, we would like to compare whether there is any difference in recovery of gastrointestinal function, diet resumption, postoperative recovery, and well-being between each group.

 Supportive Care

① The patient is assigned to the Experimentand control groups on a random basis on the eve of the operation by independent gynecologist. All patients  strictly observes the fast times of eight hours of solid form, six hours of fluid and two hours of clear fluid in a traditional way. 
② The patients in the control group (carbohydrate group) follows the protocols of our gynecologic strategy. Patiens will fast during the times of eight hours of solid form, six hours of fluid and two hours of water in a traditional way. Instead, they drink 2 cans of oral carbohydrate (NO NPO) as their dinner. In the first case of operation day, patients would drink a can of NO NPO at 5am. In other case of operation day morning, patiens would drink a can of NO NPO 3hours prior to surgery. In the other cases of operation day afternoon, patients would drink each can of NO NPO in breakfast time (7 am) and 3hours prior to surgery.
③ The patients in the test group (gum group) follows the protocols of our gynecologic strategy. Patiens will fast during the times of eight hours of solid form, six hours of fluid and two hours of water in a traditional way. Instead, they drink 2 cans of oral carbohydrate (NO NPO) as their dinner. In the first case of operation day, patients would drink a can of NO NPO. In other case of operation day morning, patiens would drink a can of NO NPO 3hours prior to surgery. In the other cases of operation day afternoon, patients would drink each can of NO NPO in breakfast time (7 am) and 3hours prior to surgery.The test group (Group G) is  allowed to chew gum that is distributed freely during fast time, while follow the fasting protocol.
④	There is no intervention other than chewing gum during fast times between the two groups of patients, and subsequent anesthesia and pre-anesthesia examinations will be the same.

Arm Label

Target Number of Participant

Arm Type

Arm Description

The patients in the control group (carbohydrate group) follows the protocols of our gynecologic strategy. Patiens will fast during the times of eight hours of solid form, six hours of fluid and two hours of water in a traditional way. Instead, they drink 2 cans of oral carbohydrate (NO NPO) as their dinner. In the first case of operation day, patients would drink a can of NO NPO. In other case of operation day morning, patiens would drink a can of NO NPO 3hours prior to surgery. In the other cases of operation day afternoon, patients would drink each can of NO NPO in breakfast time (7 am) and 3hours prior to surgery.

Arm Label

Target Number of Participant

Arm Type

Arm Description

The patients in the test group (gum group) follows the protocols of our gynecologic strategy. Patiens will fast during the times of eight hours of solid form, six hours of fluid and two hours of water in a traditional way. Instead, they drink 2 cans of oral carbohydrate (NO NPO) as their dinner. In the first case of operation day, patients would drink a can of NO NPO at 5am. In other case of operation day morning, patiens would drink a can of NO NPO 3hours prior to surgery. In the other cases of operation day afternoon, patients would drink each can of NO NPO in breakfast time (7 am) and 3hours prior to surgery.
The test group (Group G) is  allowed to chew gum that is distributed freely during fast time, while follow the fasting protocol.

Gender

Age

Description

(1) ASA class I-III adult patient (age 19 and under 70) 
(2) Patients undergoing  the laparoscopic gynecological surgery

(1) Pediatric (under 19) 
(2) Old age (over 69) 
(2) Pregnant and nursing mothers 
(3) Patients with unstable vital signs 
(4) Patients who are at high risk of aspiration 
persons with a BMI of 30 or more, gastroesophageal reflux, chronic renal failure, oesophageal structures, achalasia, enteropaties, diabets mellitus, and with a history of gastrointestinal tumors; 
(5) Any medical history that could effect GI motility 
(6) Patients with liver and kidney disease 
(6) Emergency surgery. 
(7) Patients who do not agree to participate in the study

Pre-operative anxiety

proir to induction of general anesthesia

Symptoms related to anxiety

inhospital period

Recovery or bowel function

inhospital period

bowel complication

inhospital period

Quality of recovery questionnaire ( with QoR 15 score)

inhospital period

gastric volume with gastric sonography

inhospital period

Gastric fluid  volume and acidity

inhospital period

intraoperative outcomes

intraoperative period