Advances in the Management of Perioperative Patients' Thirst

Exploring thirst incidence and risk factors in patients undergoing general anesthesia after extubation based on ERAS principles: a cross sectional study

BACKGROUND

This study aims to comprehend the levels of dry mouth and thirst in patients after general anesthesia, and to identify the factors influencing them.

METHODS

The study included all patients transferred to the Post Anesthesia Care Unit (PACU) at the Second Affiliated Hospital of Dalian Medical University between August 2021 and November 2021 after undergoing general anesthesia. A thirst numeric rating scale was utilized to conduct surveys, enabling the assessment of thirst incidence and intensity. Statistical analysis was performed to explore patient thirst levels and the associated factors.

RESULTS

The study revealed a thirst incidence rate of 50.8%. Among the thirst intensity ratings, 71.4% of patients experienced mild thirst, 23.0% reported moderate thirst, and 5.6% expressed severe thirst. Single-factor statistical analysis of potential risk factors among the enrolled cases indicated that gender, history of coronary heart disease, surgical duration, intraoperative fluid volume, intraoperative blood loss, intraoperative urine output, and different surgical departments were linked to post-anesthetic thirst in patients undergoing general anesthesia. Multifactorial Logistic regression analysis highlighted age, gender, history of coronary heart disease, fasting duration, and intraoperative fluid volume as independent risk factors for post-anesthetic thirst in patients undergoing general anesthesia. Moreover, age, gender, history of coronary heart disease, and intraoperative fluid volume were also identified as risk factors for varying degrees of thirst.

CONCLUSION

The incidence and intensity of post-anesthetic thirst after general anesthesia are relatively high. Their occurrence is closely associated with age, gender, history of coronary heart disease, fasting duration, and intraoperative fluid volume.

The Prevalence and Risk Factors for Postoperative Thirst: A Systematic Review and Meta-analysis

PURPOSE

Thirst is a symptom of dehydration and one of the main complications affecting postoperative outcomes and comfort. Persistent water scarcity can have a detrimental effect on the cognitive function and psychology of patients. However, the current evidence about the prevalence and risk factors for postoperative thirst is not fully understood. Therefore, this study aims to investigate the prevalence and risk factors of postoperative thirst and provide guidance for clinical practice.

DESIGN

Systematic review and meta-analysis.

METHODS

We searched PubMed, Cochrane Library, Web of Science, Embase, Clinicaltrials.gov, China National Knowledge Infrastructure, and Wanfang Database. Eligible studies were evaluated using the Agency for Healthcare Research and Quality. The collected data were pooled and analyzed using Stata15.0.

FINDINGS

A total of 11 cross-sectional studies were included involving 20,612 patients. Eight studies reported prevalence and the pooled prevalence of postoperative thirst was 76.8% (95% confidence interval [CI]: 0.664 to 0.858). Five studies contributed to meta-syntheses of risk factors for postoperative thirst. The results indicated that sex (odds ratio [OR] = 1.44, 95% CI = 1.13 to 1.84, I2 = 80.2%, P = .006), anesthesia drug (OR = 1.48, 95% CI = 1.06 to 2.06, I2 = 94.8%, P < .001), surgical type (OR = 0.66, 95% CI = 0.49 to 0.9, I2 = 77.9%, P = .004) were statistically associated with postoperative thirst.

CONCLUSIONS

Our study shows a high prevalence of postoperative thirst. Sex, anesthesia drug, and surgical type are risk factors that influence postoperative thirst. Nurses and other health care professionals should routinely assess the postoperative thirst of patients and perform targeted interventions to alleviate their distressing symptoms and improve the quality of care.

Effects of menthol on thirst during surgery patients fasting: A systematic review and meta-analysis of randomized controlled studies

AIMS

We aim to analyse the effect of menthol on thirst intensity and thirst comfort in surgical patients.

BACKGROUND

Menthol has achieved good results in quenching thirst in patients in intensive care units, but its safety and reliability in perioperative fasting patients are unknown.

DESIGN

A systematic review with meta-analysis of intervention studies was performed.

DATA SOURCES

We used Chinese and English databases from their dates of inception to May 2022. Literature was retrieved from PubMed, Web of Science, Cochrane Library, Embase, CINHAL, SinoMed, CNKI, Wanfang and VIP database.

REVIEW METHODS

Two reviewers independently examined the records according to the eligibility criteria and extracted the data of each included study.

RESULTS

A total of seven studies were identified in this review, which included 537 surgical patients. Overall, menthol reduced thirst intensity in surgical patients and decreased thirst discomfort. Further subgroup analysis revealed that the menthol intervention significantly improved thirst intensity in surgical patients during preoperative and postoperative fasting periods. The Egger's tests showed no significant bias (p = 0.113 and 0.553, thirst intensity and thirst discomfort, respectively).

CONCLUSION

Menthol intervention effectively improved thirst intensity and thirst discomfort during fasting in surgical patients, but more large-scale, multicentre randomized controlled trials are required to confirm these findings further.

The Effect of Menthol Ice on Laparoscopic Cholecystectomy Patients' Thirst, Dry Mouth, Mouth Taste, and Bad Mouth Odor: A Randomized Controlled Trial

PURPOSE

This study aimed to determine the effect of menthol ice application on thirst, dry mouth, mouth taste, and bad mouth odor in patients who underwent laparoscopic cholecystectomy in the postoperative period.

DESIGN

The study was conducted as a randomized controlled trial with an experimental design.

METHODS

The study sample consisted of 90 patients who underwent laparoscopic cholecystectomy and met the inclusion criteria. Patients were divided into three groups by randomization program. Patients in the menthol ice and ice popsicle (ice prepared with drinking water only) group were administered menthol ice/ice popsicle (10 mL) twice at 20 minutes intervals. Patients in the control group did not receive any intervention. Routine practices of the clinic were performed by the nurses of the general surgery clinic. Postoperative thirst intensity, severity of dry mouth, bad taste, and bad odor in the mouth were evaluated at 0, 20, and 40 minutes.

FINDINGS

No statistically significant difference was found between the sociodemographic and clinical characteristics of the patients in the control group, menthol ice group, and ice popsicle group (P > .05). A statistically significant difference was found between the 3 groups in terms of thirst intensity and severity of dry mouth at times at the 20th and 40th minutes after the application (P < .01). We found a statistically significant difference between the bad taste and bad odor sensation scores of the patients in the control and intervention groups at the 20th and 40th minutes after the application (P < .05).

CONCLUSIONS

The study concluded that menthol ice and ice popsicle application are effective strategies to reduce the intensity of thirst, severity of dry mouth, bad taste, and bad odor in postoperative patients.

Effects of cold spray on thirst, frequency of oral care, and pain of general surgery intensive care unit patients

This study aims to investigate the effects of intraoral cold water spray on thirst, frequency of oral care and postoperative period pain at surgical incision site in patients having abdominal surgery. The study was carried out as a randomized controlled trial, registered under Clinical Trial Number: NCT05940818. The study involved 110 participants, divided equally into two groups (n = 55): the experimental group and the control group. Data were collected using patient information form, NRS, Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS) and Visual Analog Scale (VAS). The severity of thirst at 1st, 8th, 16th h of post-operative period (p < 0.01) and the frequency of oral care application at 16th h were statistically significantly decreased in the experimental group when compared to the control group (p < 0.01).There wasn't statistically significant difference between the patients in the experimental and control groups in terms of pain at surgical incision site (p > 0.05). The patient's thirst and need for frequent oral care in the postoperative period were reduced by the application of a cold water spray. In patients undergoing abdominal surgery, the use of cold water spray application may be recommended to reduce thirst and the need for frequency of oral care application.

The Effect of Cold Oral Applications in the Management of Postoperative Thirst: A Systematic Review

PURPOSE

Thirst is one of the most bothersome symptoms experienced by surgical patients. Effective thirst intervention and management in the Post Anesthesia Care Unit (PACU) and hospital wards is critical because patients are less sedated and more aware than in the past. There is a need to review the literature on the identification and management of thirst in the inpatient and PACU settings. The aim of this systematic review was to examine the available evidence on the effectiveness of oral cold applications on thirst in postoperative patients.

DESIGN

This was a systematic review study. Articles in PUBMED, Web of Science, ScienceDirect, TÜBİTAK-ULAKBİM, and TRDizin databases between January 2008 and January 2023 that included oral cold applications to relieve the thirst of patients in the postoperative period were included.

METHODS

The PICOT-SD (Patients Interventions Comparison Outcome Time-Study Design) method was used as an eligibility criterion for inclusion in the study. The eligibility criteria included that the articles were written in English-Turkish and within the target dates, the studies included nursing interventions, the primary outcome of the studies was thirst, and the study sample included postoperative patients. The risk of bias was assessed using the RoB2 tool developed by Cochrane.

FINDINGS

A total of 254 articles were retrieved from the databases using the specified keywords. 244 articles did not meet the study criteria: 30 were excluded because they were not interventional studies, 61 were not conducted in a postoperative population, 56 were duplicates, and 79 were not on a related topic. A total of 10 studies consisting of randomized controlled trials and quasi-experimental articles met the criteria for our review. Oral cold applications effectively reduced the thirst rate of postoperative patients and improved their health-related quality of life. The intervention has also been shown to reduce other anesthesia-related complications.

CONCLUSIONS

This systematic review concluded that cold oral applications have promising effects on thirst, dry mouth, and health-related quality of life. Cold oral applications are cost-effective and suitable for large-scale health care applications.

Origins of thirstiness sensation and current food solutions

The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not relieved, resulting in an uncomfortable and distressing situation. The present review describes thirstiness and hydration, the food products and beverages that cause thirstiness, and the beverages and food products currently available to quench thirstiness in individuals with restricted access to liquid ingestion. It also discusses how to measure the effectiveness of calming thirstiness. To diminish thirstiness distress, different alternatives to liquids are proposed. Individuals with swallowing disorders are given thickened water, individuals with restricted water ingestion are given ice cubes or ice popsicles of different flavors, and sportspeople are given energy gels. However, current beverage solutions seem not to relieve thirst fully, although some stimuli like iced water, flavors (especially lemon and mint), or acids seem to work better than plain stimuli and could be added to existing products. Therefore, there is still a need to incorporate these strategies into beverage and food formulations and to test their effectiveness.

Clinical validation of the nursing diagnostic proposition perioperative thirst

OBJECTIVE

to verify the clinical validity of the proposition of a new nursing diagnosis called perioperative thirst, based on the diagnostic accuracy of its clinical indicators, including the magnitude of effect of its etiological factors.

METHOD

clinical diagnostic validation study with a total of 150 surgical patients at a university hospital. Sociodemographic variables and clinical indicators related to thirst were collected. The latent class analysis technique was used.

RESULTS

two models of latent classes were proposed for the defining characteristics. The model adjusted preoperatively included: dry lips, thick saliva, thick tongue, desire to drink water, caregiver report, dry throat and constant swallowing of saliva. In the postoperative period: dry throat, thick saliva, thick tongue, constant swallowing of saliva, desire to drink water, bad taste in the mouth. The factors related to "high ambient temperature" and "dry mouth" are associated with the presence of thirst, as well as the associated conditions "use of anticholinergics" and "intubation". The prevalence of thirst was 62.6% in the pre and 50.2% in the immediate postoperative period.

CONCLUSION

the diagnostic proposition of perioperative thirst showed good accuracy parameters for its clinical indicators and etiological effects. This proposition in a nursing taxonomy will allow greater visibility, appreciation and treatment of this symptom.(1) Evaluates the accuracy of the proposition of the nursing diagnosis perioperative thirst; (2) Allows refined diagnosis for use in clinical practice, teaching and research; (3) Strengthens the systematization of perioperative nursing care; (4) Highlights thirst management as part of care, considering its high prevalence and discomfort; (5) Presents a structure with good accuracy parameters which are representative of thirst.

Development of the Thirst Discomfort Scale: A Validity and Reliability Study

BACKGROUND

Thirst is a sensation associated with a dry mouth and the desire or craving to drink water. Surgical patients are among those hospitalized individuals who are at high risk of developing both osmotic and hypovolemic thirst.

OBJECTIVES

To develop a new measurement tool for evaluating the thirst-related discomfort of surgical patients and to assess its validity and reliability.

METHODS

The study population consisted of patients admitted to the surgical clinics of a research hospital in Turkey between January and March 2022. The new measurement tool was developed in several stages: a pilot implementation phase with 51 patients and the main implementation phase with 198 patients. Data were collected by means of face-to-face interviews with patients. Exploratory factor and confirmatory factor analyses were performed using IBM SPSS Statistics, version 22, and IBM SPSS Amos.

RESULTS

The final Thirst Discomfort Scale consisted of 12 items in 3 subdimensions. The Cronbach α values of the scale subdimensions ranged from 0.787 to 0.848, and the Cronbach α value for the scale as a whole was 0.886. The scale explained 66.237% of the total variance of the data.

CONCLUSION

The Thirst Discomfort Scale consisting of 12 items and 3 subdimensions is a valid and reliable measurement tool for evaluating thirst-related discomfort of surgical patients.

Prevalence of and risk factors for thirst in the intensive care unit: An observational study

AIM AND OBJECTIVES

This study investigated the incidence of thirst and contributing factors in intensive care unit (ICU) patients by analysing differences in physiologic, psychological, and disease- and environment-related parameters in ICU patients with vs without thirst.

BACKGROUND

Little is known about the factors that influence thirst, and there are no standardised methods for identifying at-risk patients in the ICU. Previous studies generalised the risk of thirst in ICU patients because of a lack of data on relevant variables. Here, we examined the factors contributing to thirst based on symptom management theory.

DESIGN

Prospective descriptive design.

METHODS

Physiologic, psychological, disease-related and environment-related data were collected for 301 patients from 4 ICUs (medical, surgical, cardiac and emergency ICUs) of a hospital from 15 December 2017-10 July 2019 through a screening interview, questionnaires and from electronic medical records. The data were analysed with descriptive statistics, the t-test and chi-squared test, and by logistic regression. Binary stepwise logistic regression was used to identify thirst-associated factors. The findings are reported according to the STROBE checklist for cross-sectional studies.

RESULTS

In total, 210/301 (69.8%) ICU patients experienced thirst. Risk factors were nil per os order (odds ratio [OR] = 4.10, 95% confidence interval [CI]: 1.44-11.69), surgery (OR = 2.96, 95% CI: 1.11-7.93), high glucose (OR = 3.36, 95% CI: 1.01-11.17) and greater disease severity (OR = 1.13, 95% CI: 1.02-1.24).

CONCLUSION

Thirst is common in ICU patients. Timely detection of patients' thirst and identification of those at high risk by ICU nurses can ensure the implementation of effective and safe interventions.

RELEVANCE TO CLINICAL PRACTICE

The results of this study highlight the need to evaluate thirst symptoms in patients with severe disease and develop relief strategies for fasting, perioperative, and hyperglycaemic patients and others who are at high risk of thirst.

PROCESS OF IMPLEMENTING THIRST MANAGEMENT IN SURGICAL BURNED PATIENTS, BASED ON KNOWLEDGE TRANSLATION

ABSTRACT Objective: to report the path taken to implement the Thirst Management Model using the Knowledge Translation Evidence-based Practice for Improving Quality intervention in a Burn unit. Method: an experience report on the implementation, which took place in two stages: Preparation; and Implementation/Change, both requiring a sequence of steps. Results: the implementation was performed in four cycles of the PDSA improvement tool. All had the same indicator collected, with increasing goals to be attained. Considering the barriers identified, multiple combined Knowledge Translation strategies were used, namely: posters; theoretical and practical training sessions, individual or in group; videos; dynamics; music; logo development for implementation visibility; audit and feedback; and didactic and illustrated clinical protocols. Conclusion: the report of the entire implementation process using the Evidence-based Practice for Improving Quality intervention, pointing out its weaknesses and strengths, proves to be useful, necessary and innovative. This study may assist in future evidence-based implementations that choose to use multifaceted interventions.

PROCESSO DE IMPLANTAÇÃO DO MANEJO DA SEDE NO PACIENTE QUEIMADO CIRÚRGICO EMBASADO NO KNOWLEDGE TRANSLATION

RESUMO Objetivo: Relatar o caminho percorrido para a implantação do Modelo de Manejo da Sede com o uso da intervenção de Knowledge Translation Evidence-based Practice for Improving Quality (Prática Baseada em Evidência para a Melhoria do Processo de Qualidade) em uma unidade de queimados. Método: Relato de experiência sobre a implantação que ocorreu em duas etapas: Preparação e Implantação/ mudança, ambas obedecendo uma sequência de passos para sua realização. Resultados: A implementação foi realizada em quatro ciclos da ferramenta de melhoria PDSA. Todos tiveram o mesmo indicador coletado, com metas crescentes a serem alcançadas. Considerando as barreiras identificadas, utilizaram-se múltiplas estratégias combinadas de Knowledge Translation: cartazes, capacitações teóricas e práticas, individuais ou em grupo, vídeos, dinâmicas, músicas, desenvolvimento de logo para visibilidade da implantação, auditoria e feedback, protocolos clínicos didáticos e ilustrados. Conclusão: O relato de todo o processo de implantação com o uso da intervenção Evidence-based Practice for Improving Quality, apontando suas fragilidades e fortalezas, mostra-se útil, necessária e inovador. Este estudo pode auxiliar futuras implantações de evidências que escolham utilizar intervenções multifacetadas.

Evaluation of Thirst in the Early Postoperative Period in Patients Undergoing Orthopedic Surgery

BACKGROUND

Thirst, is a subjective symptom that has a high incidence in the early postoperative period and causes patients to experience intense discomfort.

PURPOSE

The aim of this study is to determine thirst and the factors affecting thirst in the early postoperative period in patients undergoing orthopedic surgery.

DESIGN

The research was carried out as a descriptive-cross sectional study with 177 patients between September 2021 and January 2022.

METHODS

Data were collected using the "Descriptive and clinical features form," "Thirst and Symptoms Associated with Thirst Evaluation Form." For descriptive analysis, frequency, percentage distribution, mean, and minimum-maximum values were analyzed. The Chi-square test was used to compare the data according to the groups. Before starting the research, necessary ethics committee and institutional permission were obtained.

FINDINGS

The mean perioperative thirst time of the patients was 15.25 ± 3.61 hours and the mean anesthesia time was 2.32 ± 1.13 hours. When the perioperative thirst duration was compared with the type of surgery, duration of operation, type of anesthesia, duration of anesthesia, duration of fasting, intubation and duration of stay in PACU, there was a statistical significance between them (P > .05).

CONCLUSION

The most common symptoms in patients undergoing orthopedic surgery were thirst and dry mouth. Surgery type, operation duration, anesthesia type, anesthesia duration, fasting duration, intubation status and duration of stay in PACU were the factors affecting the perioperative thirst status of the patients.

The Practical Effect of Action Intervention Strategy Combined Based on Surgical and Psychological Factors

This study mainly analyzes the related surgical and psychological factors that cause the change of thirst degree after gastrointestinal surgery, and observes the practical effect of action intervention strategy combined with the two factors on reducing postoperative thirst degree. Based on this, the clinical data of 87 patients who underwent gastrointestinal tumor resection in our hospital from January 2020 to January 2021 is retrospectively analyzed. The degree of thirst is evaluated by the visual analogue scale (VAS) and the subjects are divided into three groups: a mild group (n = 29), a moderate group (n = 35), and a severe group (n = 23), and their psychological and surgical indicators are compared and analyzed. The results show that the thirst degree and light comfort of mouth in the study group are better than those in the control group at 2 h after surgery, and there is no significant difference when compared to 6 h after surgery, but the thirst degree and oral discomfort in the control group at 6 h after surgery are significantly higher than those in the study group at 2 h after surgery. It is suggested that an action research intervention strategy with a high practical effect can effectively reduce postoperative thirst and oral discomfort.

Effect of Standardized Perioperative Management on EEG Indexes and Nerve and Limb Functions of Patients with Acute Cerebral Infarction Undergoing Mechanical Thrombectomy

Objective

To explore the application value of standardized perioperative management in mechanical thrombectomy for acute cerebral infarction.

Methods

98 patients with acute cerebral infarction admitted to our hospital from January 2019 to January 2022 were selected as the study sample in this study, and all patients were given the standardized perioperative management. According to the interventional methods, they were divided into the thrombolytic treatment group (arteriovenous combined thrombolysis, n = 49) and mechanical thrombectomy group (mechanical thrombectomy, n = 49) to compare the nerve function, limb function, thrombolysis in myocardial infarction (TIMI) flow grade, symptomatic intracranial hemorrhage within 24 hours, acute vascular reocclusion, and the death status within 1 year and incidence of adverse events in 90 days of the two groups after treatment.

Results

After treatment, the values of brain symmetry index (BSI) and power ratio indices (DTABR) in the two groups were obviously lower than those before treatment (P < 0.05), and the values of BSI and DTABR in the mechanical thrombectomy group were lower than those in the thrombolytic treatment group (P < 0.05). According to the statistical data of National Institutes of Health Stroke Scale (NIHSS) score in patients, the NIHSS scores of the two groups after treatment were visibly decreased (P < 0.05), while the NIHSS score in the mechanical thrombectomy group after treatment was lower than that in the thrombolytic treatment group (P < 0.05). The proportion of modified Rankin scale (mRS) score < 3 in the mechanical thrombectomy group was distinctly higher than that in the thrombolytic treatment group (P < 0.05). The proportion of TIMI flow grade ≥ 2 in the mechanical thrombectomy group was significantly higher than that in the thrombolytic treatment group (P < 0.05). The rate of symptomatic intracranial hemorrhage within 24 hours in the mechanical thrombectomy group was lower than that in the thrombolytic treatment group (P < 0.05), with the indistinctive difference between the two groups (P > 0.05). The incidence of acute vascular reocclusion in the mechanical thrombectomy group was markedly lower than that in the thrombolytic treatment group (P < 0.05). There was no significant difference in 1-year mortality between the two groups (P > 0.05). In the mechanical thrombectomy group, there were 1 case of gingiva bleeding, 1 case of hemorrhinia, and 2 cases of recurrent cerebral infarction in 90 days, with a total of 4 cases (8.16%), while in the thrombolytic treatment group, there were 4 cases of gingiva bleeding, 4 cases of hemorrhinia, and 15 cases of recurrent cerebral infarction in 90 days, with a total of 23 cases (46.94%), indicating that the incidence of adverse events in 90 days in the mechanical thrombectomy group was significantly lower than that in the thrombolytic treatment group (P < 0.05).

Conclusion

The standardized perioperative management is effective in patients with acute cerebral infarction who were treated with arteriovenous combined thrombolysis or mechanical thrombectomy, which can improve the neurological function and physical function of patients. However, the mechanical thrombectomy has a better improvement effect on the neurological function and physical function of patients, with the relatively better safety, thrombolytic effect, and long-term prognosis.

Effects of carbohydrate use on preoperative thirst: a randomized clinical trial

OBJECTIVES

to evaluate the effectiveness of carbohydrate popsicles, carbohydrate solution, and usual care (fasting) on the intensity and discomfort of preoperative thirst.

METHODS

a randomized clinical trial with 60 preoperative patients aged between 18 and 60 years, randomized into three groups: control (fasting), carbohydrate solution (100 ml), and carbohydrate popsicle (100 ml). The outcomes were thirst intensity and discomfort.

RESULTS

there was a difference between groups for final thirst intensity (p = 0.01) and final thirst discomfort (p = 0.001). The effect size for both the Solution Group and the Popsicle Group was robust: 0.99 and 1.14, respectively.

CONCLUSIONS

the groups that received the carbohydrate fasting abbreviation showed a reduction in thirst discomfort compared to the control group. The carbohydrate popsicle proved more effective in reducing the intensity of thirst. NCT: 3.209.283.

Prevalence and factors associated with thirst among postsurgical patients at University of Gondar comprehensive specialized hospital. Institution-based cross-sectional study

INTRODUCTION

Thirst is a powerfully distressing sensation that occurs most frequently in the immediate postoperative period. Postoperative thirst is prevalent, the moderate-to-severe type is estimated to affect 53.2-69.8% of patients and causes significant patient discomfort.

OBJECTIVE

The objective of this study was to assess the prevalence, and factors associated with postoperative thirst among surgical patients in PACU at the University of Gondar Comprehensive Specialized Hospital from April 20 to June 27, 2021.

METHODS

An institution-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital. A total of 424 participants were included in the study. Statistical analysis had performed using SPSS 26.00 version statistical software. Binary logistic regression analysis was performed to identify the association between the prevalence of postoperative thirst and independent variables and only variables with p-value < 0.2 were entered into the multivariable analysis. The strength of the association was presented by odds ratio and 95% Confidence interval. P-value < 0.05 was considered statistically significant.

RESULT

The prevalence of postoperative thirst among postsurgical patients was 59% (95% CI = 54.74-64.13). Inadequate preloading (Adjusted odes ratio (AOR) = 2.137 95% CI 1.260-3.624), prolonged Nil Per Os (NPO) time (AOR = 13.80 95% CI 2.93-65.37), general anesthesia (AOR = 3.90 95% CI 3.56-11.25), and axillary body temperature ≥ 37.5 °C (AOR = 8.07 95% CI 3.63-17.96) were significantly associated with postoperative thirst. Low room temperature (< 20 °C) was protective for the occurrence of postoperative thirst (AOR = 0.162 95% CI 0.37-0.707).

CONCLUSION AND RECOMMENDATIONS

The prevalence of postoperative thirst remains high and need commitment in close monitoring of PACU patients and immediate intervention. We also urge that high-level, ongoing research be conducted in this area, as postoperative thirst is a very common problem with a lot to discover.

Jejum pós-operatório prolongado

Objetivo: analisar o tempo de jejum e tipo de dieta prescrita para reintrodução alimentar no pós-operatório de diferentes especialidades cirúrgicas. Método: estudo quantitativo, retrospectivo, documental e descritivo dos prontuários de pacientes cirúrgicos, com amostra randomizada e estratificada de 464 pacientes, realizado em hospital universitário público de grande porte no Paraná. Realizou-se análise estatística descritiva, apresentando medidas de tendência central e seus intervalos de confiança. Resultados: a média de jejum pós-operatório foi de 9:54h (DP: 6:89), variando de 8 a 30 horas. As clínicas que apresentaram maior tempo de jejum foram cirurgia cardíaca, cirurgia torácica e neurocirurgia, com médias de 18:25h, 14:45h e 12:22h, respectivamente. Quanto à prescrição de dieta no pós-operatório imediato, 51,3% dos pacientes receberam dieta geral, 15,3% dieta leve e 11,9% mantiveram jejum nas primeiras 24 horas após o procedimento cirúrgico. Conclusão: o tempo de jejum encontrado nessa instituição excede as atuais recomendações de protocolos nacionais e internacionais, o que implica aumento de desconfortos para o paciente cirúrgico, como sede, fome e estresse, além da insatisfação com o serviço prestado pela equipe de saúde.

Efeitos da utilização do carboidrato sobre a sede no pré-operatório: ensaio clínico randomizado

RESUMO Objetivos: avaliar a efetividade do picolé de carboidrato, solução de carboidrato e cuidado usual (jejum) sobre a intensidade e desconforto da sede no pré-operatório. Métodos: ensaio clínico randomizado, com 60 pacientes no pré-operatório, idade entre 18 e 60 anos, aleatorizados em três grupos: controle (jejum); solução de carboidrato (100 ml); picolé de carboidrato (100 ml). Os desfechos foram a intensidade e o desconforto da sede. Resultados: houve diferença entre os grupos quanto à intensidade final da sede (p = 0,01) e ao desconforto final da sede (p = 0,001). O tamanho do efeito tanto para o Grupo Solução quanto para o Grupo Picolé foi forte: 0,99 e 1,14, respectivamente. Conclusões: os grupos que receberam a abreviação do jejum com carboidrato apresentaram redução no desconforto da sede quando comparados ao grupo-controle. O picolé de carboidrato mostrou-se mais efetivo na redução da intensidade da sede. NCT: 3.209.283

Barriers and facilitators in the management of preoperative thirst of the burned patient in the light of Knowledge Translation

OBJECTIVE

To explore the perception of health care professionals about barriers and facilitators, and coping strategies for the implementation of the Thirst Management Model in the preoperative period of the burned patient.

METHOD

This is a qualitative study, anchored in the conceptual framework Knowledge Translation. The focus group technique was chosen for data collection, composed by eight key professionals, to identify barriers and facilitators in evidence implementation and to point out coping strategies for the critical nodes found. Thematic Content Analysis technique was used to evaluate the data.

RESULTS

Five categories emerged: Physical structure, environment and supplies; Particularities of the burned patient; Human Resources; Team attitude; Team training and education. Coping strategies were raised for each barrier identified.

CONCLUSION

The main barriers identified were found in the Human Resources and Team Attitude categories. The main facilitators were Particularities of the burned patient and Team training and education. The identification allowed planning coping strategies for critical nodes, providing support for scientific evidence in clinical practice.

Development and validation of a new nursing diagnosis: Perioperative thirst

PURPOSE

To develop and validate the content of the nursing diagnosis proposal for perioperative thirst.

METHODS

A content analysis by 34 judges. An online Delphi panel was used in one round, evaluating criteria of relevance, clarity and precision. Wilcoxon's one-tailed test was used and the content validity index to maintain the item was set to 0.80.

FINDINGS

The content validity index in relation to the evaluated items reached levels between 0.87-1.00. The final components of the diagnosis proposal included the following items as defining characteristics: dry mouth, dry throat, dry lips, thick saliva, thick tongue, constant swallowing of saliva, desire to drink water, bad taste in the mouth, and caregiver's report. Related factors are as follows: pre- and postoperative fasting, oral breathing, dehydration, hypovolemia, insensitive loss of hydration by breathing, dry mouth, habit of drinking water, high room temperature. Associated conditions: intubation, use of muscarinic and nicotinic anticholinergics and water restriction.

CONCLUSIONS

All components of the nursing diagnosis were validated in relation to relevance, clarity, and accuracy, demonstrating high levels of agreement between experts. Qualitative observations were found to be fundamental for both combining and excluding some items.

IMPLICATIONS FOR NURSING PRACTICE

Improvement of refinement and clarity levels of this nursing diagnosis proposal aiding its inclusion in the NANDA International taxonomy and thus enabling greater understanding of the phenomenon of thirst in surgical patients. This study helps to explain and facilitate the identification of defining characteristics, related factors, and associated conditions for nurses, nursing students, and researchers on this subject.

Use of Mentholated Popsicle in the Management of the Elderly Patient's Thirst in the Immediate Postoperative Period: A Randomized Controlled Trial

PURPOSE

This study aimed to compare a mentholated popsicle with usual care (absolute fasting) in the change in thirst intensity and discomfort in elderly patients in the immediate postoperative period (IPP).

DESIGN

A randomized controlled trial.

METHODS

The sample consisted of 50 elderly patients (60 years or older) in the IPP who were randomly assigned to two groups: experimental group (20 mL mentholated popsicle) and control group (usual care). The outcomes, thirst intensity and discomfort, were assessed at baseline and 20 minutes after the intervention.

FINDINGS

The mentholated popsicle presented a statistically significant (P < .001) decrease in thirst intensity and discomfort by 5.0 in the median and a Cohen's r large effect size for both outcomes. There were no adverse events or side effects.

CONCLUSIONS

The use of a mentholated popsicle decreased the intensity and discomfort of the elderly patient's thirst in the IPP.

Elaboration, validation and reliability of the safety protocol for pediatric thirst management

Objective:

to elaborate, validate and evaluate the reliability of the Safety Protocol for Pediatric Thirst Management in the immediate postoperative period.

Method:

methodological quantitative research, based on the assumptions on measurement instrument development. The protocol was elaborated after literature review, interview with specialists and observation of the child’s anesthetic recovery. The judges performed theoretical validation through apparent, semantic and content analysis. Content Validity Index was calculated for content validation, whose minimum established concordance was 0.80. Protocol’s reliability was evaluated in children between three and 12 years old in the Post Anesthesia Care Unit.

Results:

in its final version, the protocol consisted of five evaluation criteria: level of consciousness, movement, airway protection, breathing pattern and nausea and vomiting. It presented easy comprehension and relevant content, and all indexes exceeded the minimum agreement of 0.80. Pairs of nurses applied the protocol 116 times to 58 children, resulting in a high reliability index (kappa general = 0.98)

Conclusion:

the unprecedented protocol developed is valid and is a useful tool for use in anesthetic recovery, aiming to assess safety for reducing the thirst of infant patients.