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Disma N, Frykholm P. Clear rules for clear fluids fasting in children. Br J Anaesth 2024; 132:18-20. [PMID: 37996274 DOI: 10.1016/j.bja.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/25/2023] Open
Abstract
Preoperative fasting guidelines published in 2022 by the European Society of Anaesthesiology and Intensive Care represent a paradigm shift in the preoperative preparation of children undergoing general anaesthesia. Schmitz and colleagues report the results from a multi-institutional prospective cohort study to determine if application of the recent guidelines increased the risk of regurgitation and pulmonary aspiration. This study provides support for the concept of reducing real fasting times by allowing clear fluids until 1 h before induction of anaesthesia. Although the study cohort was large, further prospective multicentre studies with even greater sample sizes are warranted to provide definitive evidence for the safety of the new fasting rules.
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Affiliation(s)
- Nicola Disma
- Unit for Research in Anaesthesia, Department of Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Peter Frykholm
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
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2
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Nguyen H, Paluska MR, Falcon R, Petersen TR, Soneru C. Rapid Evaluation of Gastric Content With Ultrasound: An Educational Tool. Cureus 2023; 15:e49031. [PMID: 38024067 PMCID: PMC10657575 DOI: 10.7759/cureus.49031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Pulmonary aspiration is a severe complication in patients receiving anesthesia for surgical procedures. The risk and severity of aspiration are significantly higher in the presence of substantial gastric contents. Bedside ultrasound imaging of the gastric antrum is emerging as a rapid and valuable method to evaluate gastric contents before surgery. Rapid gastric ultrasound using a three-category grading system promotes timely decision-making to help in emergent or urgent surgeries by identifying patients with potentially high gastric volumes or solid food contents. In emergent cases with limited time, a single ultrasound view of the gastric antrum is still likely to yield helpful information. In this report, we argue that bedside ultrasound offers a more reliable assessment of gastric contents than assumptions based on time-based fasting guidelines.
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Affiliation(s)
- Huynh Nguyen
- Department of Medicine, The Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Matthew R Paluska
- Department of Anesthesiology, Rocky Vista University College of Osteopathic Medicine, Englewood, USA
| | - Ricardo Falcon
- Department of Anesthesiology and Critical Care, University of New Mexico School of Medicine, Albuquerque, USA
| | - Timothy R Petersen
- Office of Graduate Medical Education, University of New Mexico School of Medicine, Albuquerque, USA
- Department of Anesthesiology and Critical Care, University of New Mexico School of Medicine, Albuquerque, USA
- Department of Obstetrics & Gynecology, University of New Mexico School of Medicine, Albuquerque, USA
| | - Codruta Soneru
- Department of Anesthesiology and Critical Care, University of New Mexico School of Medicine, Albuquerque, USA
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3
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Degeeter T, Demey B, Van Caelenberg E, De Baerdemaeker L, Coppens M. Prospective audit on fasting status of elective ambulatory surgery patients, correlated to gastric ultrasound. Acta Chir Belg 2023; 123:43-48. [PMID: 34110976 DOI: 10.1080/00015458.2021.1940438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Recent guidelines advocate a preoperative fasting interval of 6 h for solid food, 4 h for breast milk and 2 h for clear fluids. Long nil per mouth intervals give rise to complications and discomfort in the perioperative period. Gastric ultrasound is easily accessible and generates reliable information about gastric content. PATIENTS AND METHODS One hundred patients were offered a questionnaire regarding preoperative fasting. Important outcome measures were hour of last meal, last clear fluids intake, the source of preoperative information. Gastric ultrasound was performed in prone position and lateral decubitus. RESULTS The mean duration of fasting for solid food was 13h29 and 9h51 for clear fluids. 48% of patients were well aware of the correct fasting guidelines. The most frequent source of information was the preoperative phone call. Gastric ultrasound only found insignificant amounts of gastric content. DISCUSSION Too few patients are aware of the correct guidelines or fear complications and therefore adhere to the nil per mouth from midnight as most conservative measure. A phone call informing patients about the hour of surgery and allowing clear fluid intake until 2 h before surgery, is still not convincing enough. Some health care providers advise their patients the nil per mouth from midnight rule, due to risk of interfering with the operating room schedule. CONCLUSION It is still difficult to implement liberal intake of clear fluids according to current guidelines. Ambulatory surgery patients have long fasting intervals with decrease of subjective well-being and increased incidence of hunger and thirst.
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Affiliation(s)
- Thibo Degeeter
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Birgit Demey
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Els Van Caelenberg
- University Hospital Ghent, Head Nurse Ambulatory Surgery Unit, Ghent, Belgium
| | - Luc De Baerdemaeker
- Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Marc Coppens
- Department of Basic and Applied Medical Sciences, Head of the Ambulatory Surgery Unit, University Hospital Ghent, Ghent University, Ghent, Belgium
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4
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Liddle C. Preoperative fasting: exploring guidelines and evidence to ensure consistent, high-quality care. Nurs Stand 2022; 37:77-82. [PMID: 36377391 DOI: 10.7748/ns.2022.e12033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/16/2022]
Abstract
Many nurses will still be familiar with the instruction 'nil by mouth from midnight' traditionally given to patients preparing to undergo surgery. National and international guidelines now promote much shorter preoperative fasting times, encapsulated in the '2-4-6 rule' - two hours for clear fluids, four hours for breast milk and six hours for solids. The latest evidence appears to show that these fasting times are in need of revision. Furthermore, there are inconsistencies in how guidelines are implemented. This article explores the guidelines and literature on preoperative fasting in adults and children to determine what the evidence is and what changes could be made to ensure consistent, high-quality patient care.
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Ong SY, Walker A. Using Kotter's 8 steps of change to tackle over-fasting of children attending day surgery. Paediatr Anaesth 2022; 32:1238-1245. [PMID: 35598179 DOI: 10.1111/pan.14499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/10/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Abstract
Over-fasting before surgery can lead to dehydration, irritability, lethargy, nausea, hypoglycemia, tricky intravenous cannulation, and decreased patient satisfaction (Newton et al., Pediatr Anesth, 2017, 27, 793). We used "Kotter's 8 steps for change" as an approach to tackling the problem of over-fasting in our day surgery unit (Kotter, Leading Change, Harvard Business School Press, 1996). Using a video of a patient's experience with overfasting, we created a sense of urgency and need for change (Step1: create urgency). We formed a multi-disciplinary fasting improvement team (FIT) (Step2: form a powerful coalition) and conducted a retrospective data analysis to establish a baseline. We then studied the system thoroughly using Ishikawa charts, process mapping, bench-marking, user surveys, and Pareto charts. Using these findings, we created a vision for our change (Step3: create a vision for change). Within 6 months, we aimed for 90% of patients to have a fluid fasting time of <2 h and for 90% of afternoon patients to have had breakfast. We communicated this vision to all staff involved in the day surgery (Step4: communicate the vision). Following this, we empowered them (Step5: empower action) by asking for their opinions for changes and let them take over various tasks without micromanagement. The Institute for Healthcare Improvement (IHI) Psychology of Change Framework described a focus on the human side of change, to increase the likelihood that improvement efforts will succeed by activating people's agency (Hilton & Anderson. IHI Psychology of Change Framework to Advance and Sustain Improvement, Institute for Healthcare Improvement, 2018). Our change ideas were divided into "short-term wins," "intermediate term goals," and "longer term goals." We focussed on creating short-term wins (Step6: create quick wins) and celebrated successes along the way to create initial momentum. We did this in parallel with working on longer term changes. We continued to work on cementing these new ideas (Step7: build on the changes), so that transformation in the day surgery would persist before using the same system to spread the change to the rest of the hospital (Step8: making it stick).
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Affiliation(s)
- Su Ying Ong
- Alder Hey Children's Hospital, Liverpool, UK
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Tofani V, Milhorini CR, Paladini GM, Gaspar LO, Garcia AKA, Pierotti I, Conchon MF, Nakaya TG, Nascimento LAD, Fonseca LF. Jejum pós-operatório prolongado. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.38657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
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.
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7
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Wahidi KR. Oncology nurses’ role in the enhanced recovery after surgery programme. Asia Pac J Oncol Nurs 2022; 9:100033. [PMID: 35607506 PMCID: PMC9123193 DOI: 10.1016/j.apjon.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
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8
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Oparin Y, Zeraatkar D, Shanthanna H, Motaghi S, Couban R, Kattail D, Paul J, Mbuagbaw L, Sadeghirad B. Preoperative fasting for prevention of perioperative complications in children. Hippokratia 2021. [DOI: 10.1002/14651858.cd013809.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yvgeniy Oparin
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | | | - Shahrzad Motaghi
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | - Rachel Couban
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Deepa Kattail
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - James Paul
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
- Centre for the Development of Best Practices in Health (CDBPH); Yaoundé Central Hospital; Yaoundé Cameroon
| | - Behnam Sadeghirad
- Department of Anesthesia; McMaster University; Hamilton Canada
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
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9
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Oparin Y, Zeraatkar D, Shanthanna H, Motaghi S, Couban R, Kattail D, Paul J, Sadeghirad B, Mbuagbaw L. Preoperative fasting for prevention of perioperative complications in children. Hippokratia 2020. [DOI: 10.1002/14651858.cd013809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yvgeniy Oparin
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | | | - Shahrzad Motaghi
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | - Rachel Couban
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Deepa Kattail
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - James Paul
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | - Lawrence Mbuagbaw
- Centre for the Development of Best Practices in Health (CDBPH); Yaoundé Central Hospital; Yaoundé Cameroon
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10
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Beck CE, Chandrakumar T, Sümpelmann R, Nickel K, Keil O, Heiderich S, Boethig D, Witt L, Dennhardt N. Ultrasound assessment of gastric emptying time after intake of clear fluids in children scheduled for general anesthesia-A prospective observational study. Paediatr Anaesth 2020; 30:1384-1389. [PMID: 32997821 DOI: 10.1111/pan.14029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND While many clinics have changed their local regimen toward a more liberal policy regarding clear fluid fasting for general anesthesia, there is a lack of studies evaluating gastric emptying time in a clinical setting. AIMS Based on this and before implementation of a more liberal preoperative clear fluid fasting policy for children, we studied gastric emptying time of clear fluids in children and hypothesized that the mean gastric emptying time would be 1 hour. METHODS Between March and December 2019, children scheduled for general anesthesia at our University Children's Hospital were enrolled in this prospective observational study. After overnight fasting, gastric emptying was examined by sonographic measurements of the gastric antral area before and 5, 15, 30, 45, and 60 minutes after intake of water or fruit juice. RESULTS Twenty-six children were enrolled in this study, and 24 aged 11 (range 4-17) years were included for statistical analysis. The median ingested fluid volume was 4.7 (range 1.8-11.8) mL kg-1 . The gastric antral area of the children initially increased and subsequently decreased after intake of clear fluids and correlated significantly with fasting time (r = -0.55, P < .0001). After 1 hour, the gastric antral area had returned to the baseline level in 20 children but not in four children with a fluid intake >5 mL kg-1 . There was no difference in the gastric antral area between water and fruit juice. Using a linear regression model, the calculated mean gastric emptying time of clear fluids was 52 minutes. CONCLUSION This study showed that the gastric emptying time of children after intake up to 5 mL kg-1 clear fluids was <1 hour in a clinical setting. These results support the more liberal fasting regimen favoring a 1-hour fasting time and suggest 5 mL kg-1 as an upper limit for clear fluids (eg, water, sugared water or tea or diluted fruit juice) from 2 hours to 1 hour before induction of anesthesia in children.
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Affiliation(s)
- Christiane E Beck
- Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany
| | | | - Robert Sümpelmann
- Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany
| | - Katja Nickel
- Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany
| | - Oliver Keil
- Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany
| | | | - Dietmar Boethig
- Department for Pediatric Cardiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Lars Witt
- Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany.,Clinic of Anesthesiology, KRH Klinikum Robert Koch, Gehrden, Germany
| | - Nils Dennhardt
- Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany
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11
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Abstract
PURPOSE OF REVIEW Preoperative fasting guidelines are generalized to elective procedures and usually do not distinguish between the ambulatory and inpatient setting. Prevalence of aspiration is low while prolonged preoperative fasting is common clinical reality. Recently, changes in preoperative fasting guidelines have been widely discussed. RECENT FINDINGS Rates of prolonged clear fluid fasting (>4 h) prior to surgery are reported in up to 80% of patients with mean fasting duration of up to 16 h and beyond. Prolonged fasting may result in adverse effects such as intraoperative hemodynamic instability, postoperative delirium, patient discomfort, and extended hospital length of stay. Liberal approaches allowing clear fluids up to 1 h prior to anesthesia or until premedication/call to the operating room have shown no increase in adverse events among children. Various anesthesia societies now encourage clear fluid intake up to 1 h prior to pediatric elective anesthesia. Similar reports in the adult cohort are scarce. SUMMARY Allowing sips of water until call to the operating room may help reducing prolonged preoperative fasting and improving patient comfort while keeping a flexibility in operating room schedule. The feasibility and safety of a liberal clear fluid fasting regimen among adults undergoing elective anesthesia needs to be evaluated in future studies.
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12
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Zeraatkar D, Shanthanna H, Mbuagbaw L, Morgan RL, Reddy D, Couban R, Paul J, Sadeghirad B. Preoperative fasting for prevention of perioperative complications in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | | | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
- Centre for the Development of Best Practices in Health (CDBPH); Yaoundé Central Hospital; Yaoundé Cameroon
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | - Desigen Reddy
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Rachel Couban
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - James Paul
- Department of Anesthesia; McMaster University; Hamilton Canada
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
- Department of Anesthesia; McMaster University; Hamilton Canada
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13
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Zhang Y, Liu D, Chen X, Ma J, Song X. An enhanced recovery programme improves the comfort and outcomes in children with obstructive sleep apnoea undergoing adenotonsillectomy: A retrospective historical control study. Clin Otolaryngol 2020; 46:249-255. [PMID: 33021037 DOI: 10.1111/coa.13655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the effects of an enhanced recovery after surgery (ERAS) programme on postoperative rehabilitation in children with obstructive sleep apnoea (OSA) during the perioperative period of adenotonsillectomy. DESIGN A retrospective historical control study. SETTING Service improvement project. PARTICIPANTS The study included 394 children with OSA (207 males, 187 females; age range, 2.5 years to 14 years) who underwent adenotonsillectomy. MAIN OUTCOME MEASURES The children who had undergone adenoidal ablation and bilateral tonsillectomy were divided into an ERAS group (208 patients) treated with the combined optimisation measures and a control group (186 patients) treated with traditional measures during the perioperative period. The postoperative incidence of complications, pain scores, anxiety scores and postoperative diets in the two groups were assessed. RESULTS Patients in the ERAS group had significantly a lower overall complication rate and incidence of fever for 2 weeks of follow-up when compared to patients in the control group through the application of perioperative optimisation measures. Furthermore, patients in the ERAS group had less post-surgical pain, had better dietary intake at days 1, 3 and 7 after surgery and had lower preoperative anxiety scores after admission education and while waiting in the operation room. CONCLUSION The ERAS programme consisting of combined optimisation measures can reduce physical and psychological trauma during the perioperative period of adenotonsillectomy performed for children with OSA.
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Affiliation(s)
- Yu Zhang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Dawei Liu
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xiumei Chen
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Jiahai Ma
- Department of Anesthesiology. Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xicheng Song
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
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15
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Balfour A, Burch J, Fecher-Jones I, Carter FJ. Understanding the benefits and implications of Enhanced Recovery After Surgery. Nurs Stand 2019; 34:70-75. [PMID: 31468822 DOI: 10.7748/ns.2019.e11306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 05/23/2023]
Abstract
Enhanced Recovery After Surgery (ERAS) programmes are an innovative approach to optimising patient outcomes in the perioperative period and have been implemented in various surgical departments across a range of specialties, with varying degrees of success. ERAS is an evidence-based, multimodal programme that has repeatedly demonstrated a reduction in post-operative complications and reduced the length of hospital stays following elective surgery. However, despite extensive evidence to support these benefits, several barriers to ERAS implementation have been identified. This article outlines the components of ERAS, focusing on the barriers to its implementation and how these could be overcome. It also discusses the implications of ERAS for patients, nurses and healthcare organisations.
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Affiliation(s)
| | - Jennie Burch
- Academic Institute, St Mark's Hospital, London, England
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16
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17
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Yang WC, Chang YJ, Lin YC, Chen CY, Peng YC, Wu HP. Survey of nil per os duration of patients admitted to the emergency department due to vomiting. Medicine (Baltimore) 2019; 98:e15087. [PMID: 30946363 PMCID: PMC6456003 DOI: 10.1097/md.0000000000015087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
During the acute phase of vomiting, even a small amount of water may not be tolerated by mouth. Early refeeding may cause re-vomiting in patients, whereas late refeeding may result in dehydration and hypoglycemia. Nil per os (NPO) may be generally recommended by primary physicians, but the appropriate NPO duration for these patients is still unclear.The study aimed to identify the ideal NPO duration for patients with acute vomiting.We prospectively recruited patients with vomiting who underwent NPO management and were administered antiemetic agents in the emergency department (ED) and the pediatric ED. The demographics, final diagnosis, clinical manifestations, medical management, NPO duration, and laboratory data were collected and analyzed to identify the ideal NPO durationA total of 304 patients with vomiting who were admitted in the ED were enrolled. The major diagnosis was acute gastroenteritis (AGE) (82.9%), followed by acute gastritis and colitis. Most patients were younger than 6 years (43.8%). Apart from abdominal pain and vomiting, nausea was the most common symptom (93.1%). NPO duration of 4 to 6 hours had the lowest rate of refeeding failure (3.7%) compared to the other NPO durations.For patients with acute vomiting who are admitted to the ED, NPO duration of 4 to 6 hours may be necessary and should be recommended by primary ED physicians.
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Affiliation(s)
- Wen-Chieh Yang
- Department of Pediatric Emergency China Medical University Children's Hospital, China Medical University
- Department of Medicine, College of Medicine, China Medical University
| | - Yu-Jun Chang
- Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital
| | - Ya-Chun Lin
- Department of Nursing, Changhua Christian Hospital, Changhua
| | - Chun-Yu Chen
- Department of Pediatric Emergency China Medical University Children's Hospital, China Medical University
- Department of Medicine, College of Medicine, China Medical University
| | - Yi-Chin Peng
- Department of Pediatric Emergency China Medical University Children's Hospital, China Medical University
- Department of Medicine, College of Medicine, China Medical University
| | - Han-Ping Wu
- Department of Pediatric Emergency China Medical University Children's Hospital, China Medical University
- Department of Medicine, College of Medicine, China Medical University
- Department of Medical Research, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
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18
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de Graaff JC, Engelhardt T. How big data shape paediatric anaesthesia. Br J Anaesth 2019; 119:448-451. [PMID: 28969311 DOI: 10.1093/bja/aex158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- J C de Graaff
- Department of Anesthesiology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - T Engelhardt
- Royal Aberdeen Children's Hospital, Aberdeen, Scotland AB25?2ZN, UK
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19
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Fawcett WJ, Thomas M. Pre-operative fasting in adults and children: clinical practice and guidelines. Anaesthesia 2018; 74:83-88. [DOI: 10.1111/anae.14500] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 01/26/2023]
Affiliation(s)
- W. J. Fawcett
- Department of Anaesthesia; Royal Surrey County Hospital NHS Foundation Trust; Guildford UK
| | - M. Thomas
- Department of Anaesthesia; Great Ormond Street Hospital for Children; NHS Foundation Trust; London UK
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20
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Schmidt A, Buehler K, Both C, Wiener R, Klaghofer R, Hersberger M, Weiss M, Schmitz A. Liberal fluid fasting: impact on gastric pH and residual volume in healthy children undergoing general anaesthesia for elective surgery. Br J Anaesth 2018; 121:647-655. [DOI: 10.1016/j.bja.2018.02.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 12/31/2022] Open
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21
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Affiliation(s)
- Steven M Green
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California
| | - Baruch S Krauss
- Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Keira P Mason
- Harvard Medical School, Boston, Massachusetts.,Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts
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Frykholm P, Schindler E, Sümpelmann R, Walker R, Weiss M. Preoperative fasting in children: review of existing guidelines and recent developments. Br J Anaesth 2018; 120:469-474. [DOI: 10.1016/j.bja.2017.11.080] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/09/2017] [Accepted: 08/12/2017] [Indexed: 12/11/2022] Open
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