Unrestricted sips of water before Caesarean section

Incidence of urinary ketosis and the effect of carbohydrate drink supplementation during fasting for elective caesarean section: Audit

Elective lower segment caesarean section patients are routinely instructed to fast from food for 6h before surgery, with clear fluids up until 2h before surgery. We conducted an audit examining the true fasting times of mothers undergoing an elective caesarean section and the incidence of urinary ketones before and after introducing a preop carbohydrate drink (Nutricia preOp 400ml) to be administered to all patients at 6am on the day of surgery. We audited 50 patients prior to introducing the preop carbohydrate drink and 54 patients after the introduction of a carbohydrate drink. We found the mean fasting time from last caloric intake was reduced from 13h 35min to 5h 5min after the introduction of a preoperative carbohydrate drink. We found that the incidence of urinary ketones was 40.4% prior to the introduction of a preoperative carbohydrate drink and 38.3% after the introduction of a preop drink (p = 1). If fasting times were limited to under 4h, the incidence of urinary ketones is 10%. Our audit demonstrates that reducing preoperative fasting times is possible and preventing metabolic derangements may be possible, requiring an approach targeted at keeping fasting times to a minimum.

Parameters that Affect the Comfort Level of Pregnant Women Before Cesarean Section: Fasting and Anxiety

PURPOSE

This study aimed to investigate whether fasting time and anxiety parameters affect pregnant women's preoperative comfort levels.

DESIGN

Cross-sectional descriptive study.

METHODS

Data were collected from pregnant women using the State-Trait Anxiety Inventory (STAI), General Comfort Questionnaire (GCQ), and Numerical Rating Scale.

FINDINGS

The mean age of the participants was 29.15 ± 4.54 years, and the spinal anesthesia rate was 65.5%. The mean fasting time was 13.16 ± 2.38 hours for solid food and 10.57 ± 2.91 hours for liquid food. The mean GCQ score was 129.82 ± 12.66, while the mean STAI subscale scores were 46.72 ± 9.37 and 43.65 ± 7.95. Moderately negative correlation was found between the total GCQ and STAI scores, while weak positive correlation was observed between the STAI score and the thirst sensation and mouth dryness.

CONCLUSIONS

The preoperative process negatively affects comfort levels of pregnant women. Interventions that reduce the fasting time and anxiety level of pregnant women will increase comfort.

Actual versus instructed fasting times and associated discomforts in women having scheduled cesarean birth

OBJECTIVES

To measure actual and instructed preoperative fasting durations in women undergoing scheduled cesarean birth, to compare these times with national guidelines for healthy patients undergoing elective procedures, and to describe discomforts associated with preoperative fasting.

DESIGN

One group, nonexperimental, comparative, descriptive.

SETTING

Nonprofit private medical center in Texas with 6,000 births/year.

PATIENTS

Convenience sample of 51 hospitalized postpartum women.

INTERVENTIONS

Participants were interviewed an average of 44 hours after their cesarean birth, and their medical records were reviewed for fasting information.

MAIN OUTCOME MEASURES

Duration of actual and instructed fasting, comparison with national guidelines, and ratings of thirst and hunger.

RESULTS

The participants fasted from liquids and solids an average of 11 and 13 hours, respectively. Both actual and instructed fasting durations were significantly longer than national guidelines. Most participants (70%) were instructed to be nulla per os after midnight whether they were to have a.m. or p.m. surgery. Thirst and hunger scores averaged 5 and 4, respectively, on a 0-10 scale.

CONCLUSION

Patients having scheduled cesarean birth fast for unnecessarily long periods. Nurses should be knowledgeable about evidence-based preoperative fasting practices and collaborate with physicians to implement them.