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Burgess R. Factors influencing the fasting decisions of day-case surgery patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:666-673. [PMID: 39023021 DOI: 10.12968/bjon.2023.0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Patients admitted on the day of surgery are asked to arrive fasted, and they often fast for longer than necessary. Although pre-assessment supports patients to prepare for surgery, little is known about how they make fasting decisions. AIMS To explore factors influencing the fasting decisions of day-case patients and how to provide information pre-operatively. METHODS A qualitative descriptive study design was used. Semi-structured telephone interviews were carried out with 10 patients recruited from a single day-case unit. Data were analysed using thematic analysis. FINDINGS Three themes provided context for fasting decisions: the operation as a serious event; the patient as an active partner; and the patient as a rule follower. Length of fast is determined by fasting decisions and practicalities. CONCLUSION Patients approach fasting decisions according to their knowledge and experience and their individual preferences for information. Pre-assessment nurses should tailor information to the patient and explain the rationale for fasting.
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Affiliation(s)
- Ruth Burgess
- Staff Nurse, Department of Cardiorespiratory Research, Leeds Teaching Hospitals Trust, Leeds
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Trinh SH, Tövisházi G, Kátai LK, Bogner LL, Maka E, Balog V, Szabó M, Szabó AJ, Gál J, Jermendy Á, Hauser B. Airway management may influence postoperative ventilation need in preterm infants after laser eye treatment. Pediatr Res 2024:10.1038/s41390-024-03356-4. [PMID: 38909156 DOI: 10.1038/s41390-024-03356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Retinopathy of prematurity is treated with laser photocoagulation under general anaesthesia with intubation using endotracheal tube (ETT), which carries a risk for postoperative mechanical ventilation (MV). Laryngeal mask airway (LMA) may provide a safe alternative. We assessed the need for postoperative MV in preterm infants who received LMA versus ETT. METHODS In this single-centre, retrospective cohort study, preterm infants who underwent laser photocoagulation between 2014-2021 were enroled. For airway management, patients received either LMA (n = 224) or ETT (n = 47). The outcome was the rate of postoperative MV. RESULTS Patients' age were 37 [35;39] weeks of postmenstrual age, median bodyweight of Group LMA was higher than Group ETT's (2110 [1800;2780] g versus 1350 [1230;1610] g, respectively, p < 0.0001). After laser photocoagulation, 8% of Group LMA and 74% of Group ETT left the operating theatre requiring MV. Multiple logistic regression revealed that the use of LMA and every 100 g increase in bodyweight significantly decreased the odds of mechanical ventilation (OR 0.21 [95% CI 0.07-0.60], and 0.73 [95% CI 0.63-0.84], respectively). Propensity score matching confirmed that LMA decreased the odds of postoperative MV (OR 0.30 [95% CI 0.11-0.70]). CONCLUSION The use of LMA is associated with a reduced need for postoperative MV. IMPACT Using laryngeal mask airway instead of endotracheal tube for airway management in preterm infants undergoing general anaesthesia for laser photocoagulation for treating retinopathy of prematurity could significantly decrease the postoperative need for mechanical ventilation. According to our current understanding, this has been the largest study investigating the effect of laryngeal mask airway during general anaesthesia in preterm infants. Our study suggests that the use of laryngeal mask airway is a viable alternative to intubation in the vulnerable population of preterm infants in need of laser treatment.
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Affiliation(s)
- Sarolta H Trinh
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Gyula Tövisházi
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
- Institute of Anaesthesiology and Perioperative Care, Semmelweis University, Budapest, Hungary
| | - Lóránt K Kátai
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Luca L Bogner
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Erika Maka
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Vera Balog
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Miklós Szabó
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Attila J Szabó
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Ágnes Jermendy
- Department of Neonatology, Paediatric Centre, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Balázs Hauser
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
- Institute of Anaesthesiology and Perioperative Care, Semmelweis University, Budapest, Hungary.
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3
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Meng W, Leung JW, Wang Z, Li Q, Zhang L, Zhang K, Wang X, Wang M, Wang Q, Shao Y, Zhang J, Yue P, Zhang L, Zhu K, Zhu X, Zhang H, Hou S, Cai K, Sun H, Xue P, Liu W, Wang H, Zhang L, Ding S, Yang Z, Zhang M, Weng H, Wu Q, Chen B, Jiang T, Wang Y, Zhang L, Wu K, Yang X, Wen Z, Liu C, Miao L, Wang Z, Li J, Yan X, Wang F, Zhang L, Bai M, Mi N, Zhang X, Zhou W, Yuan J, Suzuki A, Tanaka K, Liu J, Nur U, Weiderpass E, Li X. Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography: A single-blind, multicenter, randomized controlled trial. Chin Med J (Engl) 2024; 137:1437-1446. [PMID: 37620294 PMCID: PMC11188905 DOI: 10.1097/cm9.0000000000002820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients' recovery. METHODS This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. RESULTS The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t = 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26-0.71, P <0.001) and 0.76 (95% CI: 0.57-0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05-0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39-0.95, P = 0.028) in the multivariable models. CONCLUSION Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery. TRAIL REGISTRATION ClinicalTrials.gov , No. NCT03075280.
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Affiliation(s)
- Wenbo Meng
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Joseph W. Leung
- Division of Gastroenterology and Hepatology, UC Davis Medical Center, Sacramento, CA 95816, USA
| | - Zhenyu Wang
- Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin 300100, China
| | - Qiyong Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Hangzhou, Zhejiang 310000, China
| | - Leida Zhang
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Kai Zhang
- Hepatobiliary Surgery Department, Shandong Provincial Third Hospital, Jinan, Shandong 250000, China
| | - Xuefeng Wang
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Biliary Tract Disease Research, Shanghai 200000, China
| | - Meng Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130000, China
| | - Qi Wang
- Department of Hepatobiliary Surgery, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750000, China
| | - Yingmei Shao
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Center, Xinjiang Key Laboratory of Echinococcosis and Liver Surgery Research, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, China
| | - Jijun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030000, China
| | - Ping Yue
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Lei Zhang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Kexiang Zhu
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Xiaoliang Zhu
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Hui Zhang
- Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Senlin Hou
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Kailin Cai
- Gastrointestinal Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
| | - Hao Sun
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Ping Xue
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
| | - Wei Liu
- Division of Biliopancreatic Surgery, Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Haiping Wang
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Li Zhang
- Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin 300100, China
| | - Songming Ding
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Hangzhou, Zhejiang 310000, China
| | - Zhiqing Yang
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400000, China
| | - Ming Zhang
- Hepatobiliary Surgery Department, Shandong Provincial Third Hospital, Jinan, Shandong 250000, China
| | - Hao Weng
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Biliary Tract Disease Research, Shanghai 200000, China
| | - Qingyuan Wu
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130000, China
| | - Bendong Chen
- Department of Hepatobiliary Surgery, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750000, China
| | - Tiemin Jiang
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Center, Xinjiang Key Laboratory of Echinococcosis and Liver Surgery Research, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, China
| | - Yingkai Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030000, China
| | - Lichao Zhang
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Ke Wu
- Gastrointestinal Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
| | - Xue Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Zilong Wen
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
| | - Chun Liu
- Division of Biliopancreatic Surgery, Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Long Miao
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Zhengfeng Wang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Jiajia Li
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Xiaowen Yan
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
| | - Fangzhao Wang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Lingen Zhang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Mingzhen Bai
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Ningning Mi
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Xianzhuo Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Wence Zhou
- Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Jinqiu Yuan
- Clinical Research Centre, Scientific Research Centre, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518000 China
| | - Azumi Suzuki
- Department of Gastroenterology, Hamamatsu Medical Center, Hamamatsu 9800021, Japan
| | - Kiyohito Tanaka
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto 201101, Japan
| | - Jiankang Liu
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ula Nur
- Department of Public Health, College of Health Sciences, Qatar University, Doha 2713, Qatar
| | | | - Xun Li
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
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Rüggeberg A, Meybohm P, Nickel EA. Preoperative fasting and the risk of pulmonary aspiration-a narrative review of historical concepts, physiological effects, and new perspectives. BJA OPEN 2024; 10:100282. [PMID: 38741693 PMCID: PMC11089317 DOI: 10.1016/j.bjao.2024.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024]
Abstract
In the early days of anaesthesia, the fasting period for liquids was kept short. By the mid-20th century 'nil by mouth after midnight' had become routine as the principles of the management of 'full stomach' emergencies were extended to include elective healthy patients. Back then, no distinction was made between the withholding of liquids and solids. Towards the end of the last century, recommendations of professional anaesthesiology bodies began to reduce the fasting time of clear liquids to 2 h. This reduction in fasting time was based on the understanding that gastric emptying of clear liquids is rapid, exponential, and proportional to the current filling state of the stomach. Furthermore, there was no evidence of a link between drinking clear liquids and the risk of aspiration. Indeed, most instances of aspiration are caused by failure to identify aspiration risk factors and adjust the anaesthetic technique accordingly. In contrast, long periods of liquid withdrawal cause discomfort and may also lead to serious postoperative complications. Despite this, more than two decades after the introduction of the 2 h limit, patients still fast for a median of up to 12 h before anaesthesia, mainly because of organisational issues. Therefore, some hospitals have decided to allow patients to drink clear liquids within 2 h of induction of anaesthesia. Well-designed clinical trials should investigate whether these concepts are safe in patients scheduled for anaesthesia or procedural sedation, focusing on both aspiration risk and complications of prolonged fasting.
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Affiliation(s)
- Anne Rüggeberg
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Eike A. Nickel
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
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Mizubuti GB, Ho AMH, Silva LMD, Phelan R. Perioperative management of patients on glucagon-like peptide-1 receptor agonists. Curr Opin Anaesthesiol 2024; 37:323-333. [PMID: 38390914 DOI: 10.1097/aco.0000000000001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW To summarize the mechanism of action, clinical outcomes, and perioperative implications of glucagon-like peptide-1 receptor agonists (GLP-1-RAs). Specifically, this review focuses on the available literature surrounding complications (primarily, bronchoaspiration) and current recommendations, as well as knowledge gaps and future research directions on the perioperative management of GLP-1-RAs. RECENT FINDINGS GLP-1-RAs are known to delay gastric emptying. Accordingly, recent case reports and retrospective observational studies, while anecdotal, suggest that the perioperative use of GLP-1-RAs may increase the risk of bronchoaspiration despite fasting intervals that comply with (and often exceed) current guidelines. As a result, guidelines and safety bulletins have been published by several Anesthesiology Societies. SUMMARY While rapidly emerging evidence suggests that perioperative GLP-1-RAs use is associated with delayed gastric emptying and increased risk of bronchoaspiration (particularly in patients undergoing general anesthesia and/or deep sedation), high-quality studies are needed to provide definitive answers with respect to the safety and duration of preoperative drug cessation, and optimal fasting intervals according to the specific GLP-1-RA agent, the dose/duration of administration, and patient-specific factors. Meanwhile, clinicians must be aware of the potential risks associated with the perioperative use of GLP-1-RAs and follow the recommendations put forth by their respective Anesthesiology Societies.
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Affiliation(s)
- Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Leopoldo Muniz da Silva
- Department of Anesthesiology, São Luiz Hospital - Rede D'Or - CMA, Rua Alceu de Campos Rodrigues, São Paulo, SP, Brazil
| | - Rachel Phelan
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
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Kearney L, Craswell A, Dick N, Massey D, Nugent R. Evidence-based guidelines for intrapartum maternal hydration assessment and management: A scoping review. Birth 2024; 51:253-263. [PMID: 37803945 DOI: 10.1111/birt.12773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/09/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023]
Abstract
PROBLEM Inconsistent practice relating to intrapartum hydration assessment and management is reported, and potential harm exists for laboring women and birthing persons. BACKGROUND Labor and birth are physically demanding, and adequate nutrition and hydration are essential for labor progress. A lack of clear consensus on intrapartum hydration assessment and management during labor and birth currently exists. In addition, there is an inconsistent approach to managing hydration, often including a mixture of intravenous and oral fluids that are poorly monitored. AIM The aim of this scoping review was to identify and collate evidence-based guidelines for intrapartum hydration assessment and management of maternal hydration during labor and birth. METHODS PubMed, Embase, and CINAHL databases were searched, in addition to professional college association websites. Inclusion criteria were intrapartum clinical guidelines in English, published in the last 10 years. FINDINGS Despite searching all appropriate databases in maternity care, we were unable to identify evidence-based guidelines specific to hydration assessment and management, therefore resulting in an "empty review." A subsequent review of general intrapartum care guidelines was undertaken. Our adapted review identified 12 guidelines, seven of which referenced the assessment and management of maternal hydration during labor and birth. Three guidelines recommend that "low-risk" women in spontaneous labor at term should hold determination over what they ingest in labor. No recommendations with respect to assessment and management of hydration for women undergoing induction of labor were found. DISCUSSION Despite the increasing use of intravenous fluid as an adjunct to oral intake to maintain maternal intrapartum hydration, there is limited evidence and, subsequently, guidelines to determine best practice in this area. How hydration is assessed was also largely absent from general intrapartum care guidelines, further perpetuating potential clinical variation in this area. CONCLUSION There is an absence of guidelines specific to the assessment and management of maternal hydration during labor and birth, despite its importance in ensuring labor progress and safe care.
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Affiliation(s)
- Lauren Kearney
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Nellie Dick
- Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Debbie Massey
- Edith Cowan University, School of Nursing and Midwifery, Perth, Western Australia, Australia
| | - Rachael Nugent
- Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
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Toptas T, Ureyen I, Kahraman A, Gokkaya M, Yalcin N, Alci A, Kole MC, Kandemi̇r S, Goksu M, Akgul N, Dogan S. Impact of preoperative carbohydrate loading on postoperative course and morbidity in debulking surgery for epithelial ovarian cancer. Exp Ther Med 2024; 27:181. [PMID: 38515650 PMCID: PMC10952341 DOI: 10.3892/etm.2024.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
Despite the theoretical benefits, the favorable effect of preoperative carbohydrate loading on postoperative morbidity remains controversial. Most of the outcomes reported in the literature are derived from non-gynecologic surgery data, with only one study involving a limited number of patients specifically in gynecological oncology. The present study aimed to investigate the impact of carbohydrate loading, as a single element of enhanced recovery after surgery protocols, on postoperative course and morbidity in patients undergoing debulking surgery for epithelial ovarian cancer (EOC). The present study was a non-randomized, prospective cohort trial enrolling patients with EOC who underwent surgery between June 2018 and December 2021. An oral carbohydrate supplement with a dose of 50 g was given to patients 2-3 h before anesthesia. Data on postoperative course and morbidity were collected and compared with data of a historical cohort including consecutive patients who underwent surgery without a carbohydrate loading between January 2015 and June 2018. Analyses were performed on a total of 162 patients, including 72 patients in the carbohydrate loading group and 90 patients in the control group. Median length of hospital stay (11 days vs. 11 days; P=0.555), postoperative days 1-7 serum c-reactive protein levels (P=0.213), 30-day readmission (11.6% vs. 11.5%, P=0.985), 30-day relaparotomy (2.8% vs. 3.4%, P=0.809) and 30-day morbidity (48.6% vs. 46.7%; P=0.805) were comparable between the cohorts. No significant differences in grades of morbidities were identified between the cohorts (P=0.511). Multivariate analysis revealed that the sole independent risk factor for any postoperative morbidity was operative time. In conclusion, based on the results of the present study, postoperative course and morbidity seemed to be unaffected by carbohydrate loading in patients undergoing debulking surgery for EOC.
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Affiliation(s)
- Tayfun Toptas
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Isin Ureyen
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Alper Kahraman
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Mustafa Gokkaya
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Necim Yalcin
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Aysun Alci
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Merve Cakir Kole
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Selim Kandemi̇r
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Mehmet Goksu
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Nedim Akgul
- Department of General Surgery, Saglik Bilimleri University Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Selen Dogan
- Department of Gynecologic Oncology, Akdeniz University Medical School, Antalya 07070, Turkey
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Mackeen AD, Sullivan MV, Berghella V. Evidence-based cesarean delivery: preoperative management (part 7). Am J Obstet Gynecol MFM 2024; 6:101362. [PMID: 38574855 DOI: 10.1016/j.ajogmf.2024.101362] [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: 01/19/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
Preoperative preparation for cesarean delivery is a multistep approach for which protocols should exist at each hospital system. These protocols should be guided by the findings of this review. The interventions reviewed and recommendations made for this review have a common goal of decreasing maternal and neonatal morbidity and mortality related to cesarean delivery. The preoperative period starts before the patient's arrival to the hospital and ends immediately before skin incision. The Centers for Disease Control and Prevention recommends showering with either soap or an antiseptic solution at least the night before a procedure. Skin cleansing in addition to this has not been shown to further decrease rates of infection. Hair removal at the cesarean skin incision site is not necessary, but if preferred by the surgical team then clipping or depilatory creams should be used rather than shaving. Preoperative enema is not recommended. A clear liquid diet may be ingested up to 2 hours before and a light meal up to 6 hours before cesarean delivery. Consider giving a preoperative carbohydrate drink to nondiabetic patients up to 2 hours before planned cesarean delivery. Weight-based intravenous cefazolin is recommended 60 minutes before skin incision: 1-2 g intravenous for patients without obesity and 2 g for patients with obesity or weight ≥80 kg. Adjunctive azithromycin 500 mg intravenous is recommended for patients with labor or rupture of membranes. Preoperative gabapentin can be considered as a way to decrease pain scores with movement in the postoperative period. Tranexamic acid (1 g in 10-20 mL of saline or 10 mg/kg intravenous) is recommended prophylactically for patients at high risk of postpartum hemorrhage and can be considered in all patients. Routine use of mechanical venous thromboembolism prophylaxis is recommended preoperatively and is to be continued until the patient is ambulatory. Music and active warming of the patient, and adequate operating room temperature improves outcomes for the patient and neonate, respectively. Noise levels should allow clear communication between teams; however, a specific decibel level has not been defined in the data. Patient positioning with left lateral tilt decreases hypotensive episodes compared with right lateral tilt, which is not recommended. Manual displacers result in fewer hypotensive episodes than left lateral tilt. Both vaginal and skin preparation should be performed with either chlorhexidine (preferred) or povidone iodine. Placement of an indwelling urinary catheter is not necessary. Nonadhesive drapes are recommended. Cell salvage, although effective for high-risk patients, is not recommended for routine use. Maternal supplemental oxygen does not improve outcomes. A surgical safety checklist (including a timeout) is recommended for all cesarean deliveries.
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Affiliation(s)
- A Dhanya Mackeen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger, Danville, PA (Drs Mackeen and Sullivan).
| | - Maranda V Sullivan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger, Danville, PA (Drs Mackeen and Sullivan)
| | - Vincenzo Berghella
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA (Dr Berghella)
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Dai S, Chen L, Wu M, Guo L, Wang R. Timing of early water intake post-general anaesthesia: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:135. [PMID: 38594662 PMCID: PMC11003094 DOI: 10.1186/s12871-024-02520-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Early water intake has gained widespread attention considering enhanced recovery after surgery (ERAS). In the present systematic evaluation and meta-analysis, we assessed the effects of early water intake on the incidence of vomiting and aspiration in adult patients who received general anaesthesia on regaining consciousness during the resuscitation period. OBJECTIVE To systematically analyse the results of randomised controlled trials on early postoperative water intake in patients who underwent different types of surgery under general anaesthesia, both at home and abroad, to further explore the safety and application of early water intake and provide an evidence-based foundation for clinical application. DESIGN Systematic review and meta-analysis. METHODS To perform the systematic evaluation and meta-analysis, we searched the Web of Science, CINAHL, Embase, PubMed, Cochrane Library, Sinomed, China National Knowledge Infrastructure (CNKI), Wanfang, and Vipshop databases to identify randomised controlled trial studies on early water intake in adult patients who received general anaesthesia. RESULTS Herein, we included 10 publications with a total sample size of 5131 patients. Based on statistical analysis, there was no statistically significant difference in the incidence of vomiting (odds ratio [OR] = 0.81; 95% confidence interval [CI] [0.58-1.12]; p = 0.20; I-squared [I2] = 0%) and aspiration (OR = 0.78; 95%CI [0.45-1.37]; p = 0.40; I2 = 0%) between the two groups of patients on regaining consciousness post-general anaesthesia. CONCLUSION Based on the available evidence, early water intake after regaining consciousness post-anaesthesia did not increase the incidence of adverse complications when compared with traditional postoperative water abstinence. Early water intake could effectively improve patient thirst and facilitate the recovery of gastrointestinal function.
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Affiliation(s)
- Suwan Dai
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Lingyan Chen
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Min Wu
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Liangyou Guo
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Rong Wang
- The First Hospital of Jiaxing, Jiaxing, China.
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10
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Lim L, Park SJ, Kang C, Oh SY, Ryu HG, Lee H. Perioperative urinary ketosis and metabolic acidosis in patients fasted for undergoing gynecologic surgery. Acta Anaesthesiol Scand 2024. [PMID: 38581223 DOI: 10.1111/aas.14424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Our bodies have adaptive mechanisms to fasting, in which glycogen stored in the liver and muscle protein are broken down, but also lipid mobilisation is triggered. As a result, glycerol and fatty acids are released into the bloodstream, increasing the production of ketone bodies in liver. However, there are limited studies on the incidence of perioperative urinary ketosis, the intraoperative blood glucose changes and metabolic acidosis after fasting for surgery in non-diabetic adult patients. METHODS We conducted a retrospective cohort study involving 1831 patients undergoing gynecologic surgery under general anesthesia from January to December 2022. Ketosis was assessed using a postoperative urine test, while blood glucose levels and acid-base status were collected from intraoperative arterial blood gas analyses. RESULTS Of 1535 patients who underwent postoperative urinalysis, 912 (59.4%) patients had ketonuria. Patients with ketonuria were younger, had lower body mass index, and had fewer comorbidities than those without ketonuria. After adjustments, younger age, higher body mass index and surgery starting late afternoon were significant risk factors for postoperative ketonuria. Of the 929 patients assessed with intraoperative arterial blood gas analyses, 29.0% showed metabolic acidosis. Multivariable logistic regression revealed that perioperative ketonuria and prolonged surgery significantly increased the risk for moderate-to-severe metabolic acidosis. CONCLUSION Perioperative urinary ketosis and intraoperative metabolic acidosis are common in patients undergoing gynecologic surgery, even with short-term preoperative fasting. The risks are notably higher in younger patients with lower body mass index. Optimization of preoperative fasting strategies including implementation of oral carbohydrate loading should be considered for reducing perioperative metabolic derangement due to ketosis.
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Affiliation(s)
- Leerang Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Joon Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Christine Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Young Oh
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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11
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Aydın BS, Güldoğan IK. Determinants of gastric residual volume before elective surgery in diabetic patients: An observational study. Saudi J Anaesth 2024; 18:167-172. [PMID: 38654864 PMCID: PMC11033908 DOI: 10.4103/sja.sja_339_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/15/2023] [Indexed: 04/26/2024] Open
Abstract
Background We investigated factors affecting the low- and high-risk groups for aspiration by measuring gastric volume with ultrasound in diabetic patients who fasted for elective surgery. Methods The study was conducted as an observational study. Sixty-five patients scheduled for elective surgery, aged 18-86 years, with American Society of Anesthesiologists (ASA) scores II-III, and who have diabetes were included after local ethics committee approval. Written informed consent was obtained from all participants. Demographic data of cases were recorded. Patients whose gastric residual volume (GRV) was calculated using the pupils equal, round, reactive to light, and accommodation (PERLA) formula following gastric antrum measurement in the right lateral decubitus and supine position by ultrasound were categorized as low or high risk for aspiration. Results Thirty-one patients were in the low-risk group, and 34 patients were in the high-risk group. Sex, weight, body mass index (BMI), hemoglobin A1c (HbA1c) values, and duration of diabetes were not statistically significant (p > 0.5). Age (p = 0.006) and fasting blood glucose (FBG) (p = 0.005) were statistically significant. The risk of aspiration decreases with age. Hyperglycemia is related to delayed gastric emptying and a high risk for aspiration. The duration of fasting, GRV, and cross-sectional area (CSA) were statistically significant (p = 0.017, p = 0.000, and p = 0.000, respectively). Conclusion Gastric emptying might be delayed in diabetic patients resulting in a high risk for aspiration pneumonia. The risk of aspiration increases in young diabetic patients, and preoperative FBG measurements can provide an idea about gastric emptying in diabetic patients. Gastric ultrasound (USG) may contribute to guidelines for determining more appropriate fasting times for other patient populations, such as obese, pregnant, or child patients.
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Affiliation(s)
- Berrak Sebil Aydın
- Department of Anesthesiology and Reanimation, Tepecik Training and Research Hospital, Turkey
| | - Işıl Köse Güldoğan
- Department of Anesthesiology and Reanimation, Tepecik Training and Research Hospital, Turkey
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12
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Grant MC, Crisafi C, Alvarez A, Arora RC, Brindle ME, Chatterjee S, Ender J, Fletcher N, Gregory AJ, Gunaydin S, Jahangiri M, Ljungqvist O, Lobdell KW, Morton V, Reddy VS, Salenger R, Sander M, Zarbock A, Engelman DT. Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS). Ann Thorac Surg 2024; 117:669-689. [PMID: 38284956 DOI: 10.1016/j.athoracsur.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/27/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
Enhanced Recovery After Surgery (ERAS) programs have been shown to lessen surgical insult, promote recovery, and improve postoperative clinical outcomes across a number of specialty operations. A core tenet of ERAS involves the provision of protocolized evidence-based perioperative interventions. Given both the growing enthusiasm for applying ERAS principles to cardiac surgery and the broad scope of relevant interventions, an international, multidisciplinary expert panel was assembled to derive a list of potential program elements, review the literature, and provide a statement regarding clinical practice for each topic area. This article summarizes those consensus statements and their accompanying evidence. These results provide the foundation for best practice for the management of the adult patient undergoing cardiac surgery.
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Affiliation(s)
- Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Cheryl Crisafi
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Adrian Alvarez
- Department of Anesthesia, Hospital Italiano, Buenos Aires, Argentina
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary E Brindle
- Departments of Surgery and Community Health Services, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joerg Ender
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Nick Fletcher
- Institute of Anesthesia and Critical Care, Cleveland Clinic London, London, United Kingdom; St George's University Hospital, London, United Kingdom
| | - Alexander J Gregory
- Department of Anesthesia, Perioperative and Pain Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Serdar Gunaydin
- Department of Cardiovascular Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, London, United Kingdom
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Kevin W Lobdell
- Regional Cardiovascular and Thoracic Quality, Education, and Research, Atrium Health, Charlotte, North Carolina
| | - Vicki Morton
- Clinical and Quality Outcomes, Providence Anesthesiology Associates, Charlotte, North Carolina
| | - V Seenu Reddy
- Centennial Heart & Vascular Center, Nashville, Tennessee
| | - Rawn Salenger
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael Sander
- Department of Anaesthesiology, Operative Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Giessen, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
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Kannamani B, Panneerselvam S, Rudingwa P, Badhe AS, Govindaraj K, Ramamoorthy SV. Comparison of ultrasonographic measurement of gastric antral volume and pH with or without pharmacological acid aspiration prophylaxis in low-risk surgical patients - A randomized clinical trial. J Anaesthesiol Clin Pharmacol 2024; 40:299-304. [PMID: 38919423 PMCID: PMC11196045 DOI: 10.4103/joacp.joacp_412_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 06/27/2024] Open
Abstract
Background and Aims The role of preoperative pharmacological prophylaxis in preventing aspiration pneumonitis under general anesthesia (GA) in patients at low risk of aspiration pneumonitis is still under debate. We addressed the need for routine pharmacological aspiration prophylaxis in at-risk population by assessing the change in gastric volume using ultrasound with and without pharmacological acid aspiration prophylaxis. Material and Methods A single-center, randomized double-blinded trial, with 200 adult patients scheduled for elective surgical procedures under GA, were randomized into a prophylaxis group, in which the patients received oral famotidine and metoclopramide, and a no prophylaxis group, in which the patients did not receive any prophylaxis. Gastric volume derived from preinduction measurement of gastric antral volume by ultrasound, postinduction gastric pH, and incidences of aspiration pneumonitis were compared. Bland-Altman plot was used to determine the level of agreement between measured gastric volume and ultrasonography based on calculated gastric volume. Results The gastric antral cross-sectional area (CSA) and volume in the no prophylaxis group (3.12 cm2 and 20.11 ml, respectively) were comparable to the prophylaxis group (2.56 cm2 and 19.67 ml, respectively) (P-values 0.97 and 0.63, respectively). Although there was a statistically significant decrease in gastric pH in the no prophylaxis group (P-value 0.01), it was not clinically significant to increase the risk of aspiration pneumonitis based on Roberts and Shirley criteria (P-value 0.39). Conclusion In an adequately fasted low-risk population, the amount of residual gastric volume was similar and below the aspiration threshold, regardless of the aspiration prophylaxis status.
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Affiliation(s)
- Balaji Kannamani
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sakthirajan Panneerselvam
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Priya Rudingwa
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ashok S. Badhe
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kirthiha Govindaraj
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Srivats V. Ramamoorthy
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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14
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Shi H, Zheng C, Zhu B. Effects of Preoperative Oral Carbohydrate on Perioperative Maternal Outcomes Undergoing Cesarean Section: A Systematic Review and Meta-Analysis. Anesthesiol Res Pract 2024; 2024:4660422. [PMID: 38586152 PMCID: PMC10999288 DOI: 10.1155/2024/4660422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Preoperative oral carbohydrate (CHO) is a rapid postoperative rehabilitation protocol that improves perioperative outcomes and is widely used in adult surgical patients. However, pregnant women are excluded because of the possibility of aspiration due to delayed gastric emptying. This meta-analysis was conducted to evaluate the efficacy of preoperative oral CHO in elective cesarean section. Methods PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to July 2023. Randomized controlled trials were included. The risk of bias was assessed using the Cochrane tool. Risk ratios and 95% confidence intervals were calculated. Meta-analysis was performed using random-effects models to estimate risk ratios and mean differences (MDs) with 95% confidence intervals (CIs). The outcomes included thirst and hunger scores, incidence of vomiting and nausea, time to flatus, and homeostatic model assessment of insulin resistance (HOMA-IR). Results A total of nine studies with 1211 patients were included in the analysis. The levels of thirst and hunger were evaluated using a 10-point visual analog scale, with 0 representing the best and 10 representing the worst. The severity of hunger (weighted mean difference (WMD: -2.34, 95% CI: -3.13 to -1.54), time to flatus (WMD: -3.51 hours, 95% CI: -6.85 to -0.17), and HOMA-IR (WMD: -1.04, 95% CI: -1.31 to -0.77) were significantly lower in the CHO group compared to the control group. However, there were no significant differences in the severity of thirst or the incidence of vomiting and nausea between the CHO and control groups. Conclusion Preoperative oral CHO during cesarean section alleviates thirst and hunger, shortens the time of postoperative flatus, and reduces HOMA-IR. However, the available evidence is insufficient to reach a clear consensus on the benefits or harms of preoperative oral CHO during cesarean section. Therefore, it is premature to make a definitive recommendation for or against its routine use.
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Affiliation(s)
- Haibin Shi
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
| | - Caihong Zheng
- Department of Anesthesiology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
| | - Bin Zhu
- Department of Anesthesiology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
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Ng YL, Segaran S, Yim CCW, Lim BK, Hamdan M, Gan F, Tan PC. Preoperative free access to water compared to fasting for planned cesarean under spinal anesthesia: a randomized controlled trial. Am J Obstet Gynecol 2024:S0002-9378(24)00447-2. [PMID: 38521233 DOI: 10.1016/j.ajog.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Contemporary guidance for preoperative feeding allows solids up to 6 hours and clear fluids up to 2 hours before anesthesia. Clinical trial evidence to support this approach for cesarean delivery is lacking. Many medical practitioners continue to follow conservative policies of no intake from midnight to the time of surgery, especially in pregnant women. OBJECTIVE This study aimed to evaluate the pragmatic approach of permitting free access to water up to the call to dispatch to the operating theater vs fasting from midnight in preoperative oral intake restriction for planned cesarean delivery under spinal anesthesia on perioperative vomiting and maternal satisfaction. STUDY DESIGN A randomized controlled trial was conducted in the obstetrical unit of the University of Malaya Medical Centre from October 2020 to May 2022. A total of 504 participants scheduled for planned cesarean delivery were randomized: 252 undergoing preoperative free access to water up to the call to dispatch to the operating theater (intervention group) and 252 undergoing fasting from midnight (fasting arm). The primary outcomes were perioperative vomiting and maternal satisfaction. Analyses were performed using t test, Mann-Whitney U test, and chi-square test, as appropriate. RESULTS Of note, 9 of 252 patients (3.6%) in the intervention group and 24 of 252 patients (9.5%) in the control group had vomiting at up to 6 hours after completion of cesarean delivery (relative risk, 0.38; 95% confidence interval, 0.18-0.79; P=.007), and the maternal satisfaction scores (0-10 visual numerical rating scale) were 9 (interquartile range, 8-10) in the intervention group and 5 (interquartile range, 3-7) in the control group (P<.001). Assessed before dispatch to the operating theater, feeling of thirst was reported by 69 of 252 patients (27.4%) in the intervention group and 134 of 252 patients (53.2%) in the control group (relative risk, 0.52; 95% confidence interval, 0.41-0.65; P<.001), capillary glucose levels were 4.8±0.7 mmol/L in the intervention group and 4.9±0.8 mmol/L in the control group (P=.048), and preoperative intravenous fluid hydration was commenced in 49 of 252 patients (19.4%) in the intervention group and 76 of 252 patients (30.2%) in the control group (relative risk, 0.65; 95% confidence interval, 0.47-0.88; P=.005). In the operating theater, ketone was detected in the catheterized urine in 38 of 252 patients (15.1%) in the intervention group and 78 of 252 patients (31.0%) in the control group (relative risk, 0.49; 95% confidence interval, 0.25-0.59; P<.001), and the numbers of doses of vasopressors needed to correct hypotension were 2.3±1.7 in the intervention group and 2.7±2.2 in the control (P=.009). The recommendation rates for preoperative oral intake regimen to a friend were 95.2% (240/252) in the intervention group and 39.7% (100/252) in the control group (relative risk, 2.40; 95% confidence interval, 2.06-2.80; P<.001), in favor of free access to water. Other assessed maternal and neonatal outcomes were not different. CONCLUSION Compared with fasting, free access to water in planned cesarean delivery reduced perioperative vomiting and was strongly favored by women. In addition, several pre- and intraoperative secondary outcomes were improved. However, postcesarean delivery recovery and neonatal outcomes were not different.
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Affiliation(s)
- Yee Ling Ng
- Faculty of Medicine, Departments of Obstetrics and Gynecology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sabeetha Segaran
- Faculty of Medicine, Departments of Obstetrics and Gynecology, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Boon Kiong Lim
- Faculty of Medicine, Departments of Obstetrics and Gynecology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mukhri Hamdan
- Faculty of Medicine, Departments of Obstetrics and Gynecology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Farah Gan
- Faculty of Medicine, Departments of Obstetrics and Gynecology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Peng Chiong Tan
- Faculty of Medicine, Departments of Obstetrics and Gynecology, Universiti Malaya, Kuala Lumpur, Malaysia.
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16
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Xue Y, Wang Q, Zhao H, Pan R, Xia Y, Wang H, Qin X. The efficacy and safety of modified ultraearly oral hydration for alleviating thirst in patients after thoracoscopic surgery: a prospective randomized controlled trial. BMC Anesthesiol 2024; 24:105. [PMID: 38504189 PMCID: PMC10949755 DOI: 10.1186/s12871-024-02497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE Postoperative fasting following thoracoscopic surgery can cause intense thirst and oral discomfort. However, there is currently no research on ultraearly oral hydration (UEOH) in middle-aged or elderly patients after thoracoscopic surgery. The aim of this study was to investigate the effectiveness and safety of UEOH for improving oral discomfort after thoracoscopic surgery. METHODS This single-center prospective double-blind randomized controlled trial was conducted from April 2022 to November 2023. A total of 64 middle-aged and elderly patients who underwent the first thoracoscopic surgery on the day were enrolled at our institution. Postoperatively, in the Postanesthesia Care Unit (PACU), patients were randomly assigned at a 1:1 ratio to either the UEOH group or the standard care (SC) group. The primary outcome was the patient's thirst score at 6 h after surgery. Secondary outcomes included the incidence of postoperative oral discomfort; pain scores; the occurrence of adverse reactions such as nausea, vomiting, regurgitation and aspiration; anxiety scores on the first postoperative day; the time to first flatus; and recovery satisfaction scores. RESULTS The demographic and surgical characteristics were similar between the two groups. Patients in the UEOH group had lower thirst scores 6 h after surgery than did those in the SC group(16.1 ± 6.70 vs. 78.4 ± 8.42, P < 0.01). The incidence of postoperative oral discomfort (P < 0.01), anxiety scores on the first postoperative day (P<0.05), and time to first flatus (P<0.05) were better in the UEOH group. Additionally, the incidences of adverse reactions, such as postoperative nausea, vomiting, regurgitation and aspiration, were similar between the two groups (P>0.05). CONCLUSION For middle-aged and elderly patients undergoing thoracoscopic surgery, the use of a modified UEOH protocol postoperatively can improve thirst and promote gastrointestinal recovery without increasing complications. TRIAL REGISTRATION This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 07/12/2023 with the registration number ChiCTR2300078425.
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Affiliation(s)
- Yan Xue
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Qian Wang
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Hongyu Zhao
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Ren Pan
- Department of Pain Management, Dongguan Songshan LakeCentral Hospital, Dongguan, 523320, Guangdong Province, China
| | - Yanfei Xia
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Hongmei Wang
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Xiarong Qin
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China.
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Bouvet L, Fabre J, Roussin C, Nadal C, Dezavelle S, Vial F, Le Gouez A, Soued M, Keita H, Zein W, Desgranges FP, Thuet V, Boucekine M, Duclos G, Leone M, Zieleskiewicz L. Prevalence and factors associated with high-risk gastric contents in women admitted to the maternity unit for childbirth: a prospective multicentre cohort study. Br J Anaesth 2024; 132:553-561. [PMID: 38177007 DOI: 10.1016/j.bja.2023.11.043] [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: 05/16/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND This multicentre prospective observational study sought to determine the prevalence and the factors associated with high-risk gastric contents in women admitted to the maternity unit for childbirth, and to identify the clinical situations in which ultrasound assessment of gastric contents would be most helpful (i.e. when the prevalence of high-risk gastric contents is close to 50%). METHODS Ultrasound assessments of gastric contents were performed within the first hour after admission to the maternity unit. The prevalence of high-risk gastric contents was calculated and variables associated with high-risk gastric contents were identified using logistic regression analyses. RESULTS A total of 1003 parturients were analysed. The prevalence of high-risk gastric contents was 70% (379/544; 95% confidence interval: 66-74%) in women admitted in spontaneous labour and 65% (646/1003; 95% confidence interval: 61-67%) in the whole cohort. Lower gestational age, increased fasting duration for solids, and elective Caesarean delivery were independently associated with reduced likelihood of high-risk gastric contents. In women admitted in spontaneous labour and in the whole cohort, the prevalence of high-risk gastric contents ranged from 85% to 86% for fasting duration for solids <6 h, 63%-68% for fasting 6-8 h, 54%-55% for fasting 8-12 h, and 47%-51% for fasting ≥12 h. CONCLUSIONS Around two-thirds of parturients had high-risk gastric contents within the first hour after admission to the maternity unit. Our results suggest that gastric emptying for solids continues in labouring women, and that gastric ultrasound would be most helpful when fasting duration is ≥8 h.
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Affiliation(s)
- Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France; Research Unit APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Juliette Fabre
- Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France
| | - Charlotte Roussin
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Camille Nadal
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Sylvain Dezavelle
- Department of Anaesthesiology and Intensive Care, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Florence Vial
- Department of Anaesthesiology and Intensive Care, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Agnès Le Gouez
- Department of Anaesthesiology and Intensive Care, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, France
| | - Mickael Soued
- Department of Anaesthesiology and Intensive Care, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, France
| | - Hawa Keita
- Department of Anaesthesiology and Intensive Care, Hôpital Necker Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Waed Zein
- Department of Anaesthesiology and Intensive Care, Hôpital Necker Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - François-Pierrick Desgranges
- Research Unit APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France; Department of Anaesthesiology and Intensive Care, L'Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | - Vincent Thuet
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mohamed Boucekine
- Department of Biostatistics, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Gary Duclos
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Marc Leone
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Laurent Zieleskiewicz
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Ricci Z, Colosimo D, Saccarelli L, Pizzo M, Schirru E, Giacalone S, Mancinelli P, Baldini G, Serio P. Preoperative clear fluids fasting times in children: retrospective analysis of actual times and complications after the implementation of 1-h clear fasting. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:12. [PMID: 38350987 PMCID: PMC10865513 DOI: 10.1186/s44158-024-00149-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/02/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Preoperative fasting before elective pediatric surgery is a matter of ongoing debate. The objectives of this study were to evaluate the compliance to a recently implemented preoperative fasting protocol (clear fluids until 1 hour from the induction of anesthesia), to identify predictors of prolonged preoperative fasting time, and to determine whether duration of preoperative fasting was associated with adverse outcomes. METHODS Retrospective single-center study in an operating theater of a tertiary pediatric hospital. RESULTS In a 6-month period, 1820 consecutive patients were analyzed. The data collected in the questionnaire reporting the time of last food, milk and/or liquid intake, and eventual reasons for nonadherence was analyzed. Median (interquartile range) preoperative fasting time was 186 (110-345) min. In 502 patients (27.6%), duration of preoperative fasting to clear fluid ranged from 60 to 119 min, whereas in 616 (34%) it was 120-240 min. The reasons for not respecting fasting time rules are mostly related to communication issues or unwillingness by the patients. A significant difference in fasting times was evident between infants and children older than 10 years (188, 105-290 vs. 198, 115-362; p = 0.02). Fasting times were significantly shorter in the inpatient group and in the first scheduled patients of the morning. Clear fluids fasting times were significantly longer in patients with hypovolemia complications than in those without, 373 (185-685) vs. 180 (110-330) min (p < 0.0001). Longer fasting times to clear fluids, younger age, and scheduled surgery time were independently associated with the odds of experiencing complications. CONCLUSIONS In this single pediatric center study, median clear fluids fasting time was three times higher (180 min) than those recommended by the preoperative fasting protocol. Compliance to the protocol was observed in approximately 1 out of 4 patients (27.6%). Longer fasting times were associated with an increased risk of complications, which might be due to dehydration and/or hypovolemia.
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Affiliation(s)
- Zaccaria Ricci
- Anesthesiology Unit, Department of Anesthesia and Critical Care, Meyer Children's Hospital, IRCCS, Florence, Italy.
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy.
- Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Meyer, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Denise Colosimo
- Anesthesiology Unit, Department of Anesthesia and Critical Care, Meyer Children's Hospital, IRCCS, Florence, Italy
| | - Luca Saccarelli
- Anesthesiology Unit, Department of Anesthesia and Critical Care, Meyer Children's Hospital, IRCCS, Florence, Italy
| | - Mariateresa Pizzo
- Anesthesiology Unit, Department of Anesthesia and Critical Care, Meyer Children's Hospital, IRCCS, Florence, Italy
| | - Elena Schirru
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
| | - Salvatore Giacalone
- Anesthesiology Unit, Department of Anesthesia and Critical Care, Meyer Children's Hospital, IRCCS, Florence, Italy
| | - Paola Mancinelli
- Neuro-anesthesiology Unit, Department of Anesthesia and Critical Care, Meyer Children's Hospital, IRCCS, Florence, Italy
| | - Gabriele Baldini
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
| | - Paola Serio
- Anesthesiology Unit, Department of Anesthesia and Critical Care, Meyer Children's Hospital, IRCCS, Florence, Italy
- Neuro-anesthesiology Unit, Department of Anesthesia and Critical Care, Meyer Children's Hospital, IRCCS, Florence, Italy
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Bouvet L, Bonnet MP, Keita-Meyer H, Benhamou D. Fasting or eating during labour? It is time to move forward. Anaesth Crit Care Pain Med 2024; 43:101311. [PMID: 37865215 DOI: 10.1016/j.accpm.2023.101311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Lionel Bouvet
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France, and APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Marie-Pierre Bonnet
- Sorbonne Université, Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Armand-Trousseau hospital, DMU DREAM, APHP, GRC29, Paris, France, and Université Paris Cité, Inserm, Inrae, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), U1153 CRESS, Paris, France
| | - Hawa Keita-Meyer
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France, and Centre - Université de Paris, France, Unité de Recherche EA 7323 Pharmacologie et Evaluation des Thérapeutiques Chez l'Enfant et la Femme Enceinte, Université de Paris, France
| | - Dan Benhamou
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, France, and Université Paris Saclay, Paris, France
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Ali M, Uslu A, Bodin L, Andersson H, Modiri AR, Frykholm P. Effects of caloric and nutrient content of oral fluids on gastric emptying in volunteers: a randomised crossover study. Br J Anaesth 2024; 132:260-266. [PMID: 38008651 DOI: 10.1016/j.bja.2023.10.030] [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: 04/28/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Previous studies demonstrated conflicting results regarding the determinants of gastric emptying for fluids. Our aim was to compare gastric emptying times of fluids with different caloric and nutrient content. METHODS Healthy adult volunteers underwent gastric ultrasound assessment for 4 h after consuming beverages with different caloric and nutrient content using a crossover design (oat drink with 3% fat [310 kcal], mango juice [310 kcal], oat drink with 0.5% fat [185 kcal], and blackcurrant juice [175 kcal]). Gastric emptying time, gastric content volume, and the area under the curve (AUC) of gastric content volume-time profiles were calculated. RESULTS Eight females and eight males completed the study protocol. The mean (sd) gastric emptying times were 89 (32) min for blackcurrant juice, 127 (54) min for oat drink with 0.5% fat, 135 (36) min for mango juice, and 152 (40) min for oat drink with 3% fat. Gastric emptying times were slower for oat drink with 3% fat (P=0.007) and mango juice (P=0.025) than for blackcurrant juice. At 1 h after ingestion, gastric content volume was greater for mango juice (P=0.021) and oat drink with 3% fat (P=0.003) than for blackcurrant juice. The AUC was greater for oat drink with 3% fat than mango juice (P=0.029), oat drink with 0.5% fat (P=0.004), and blackcurrant juice (P=0.002), and for mango juice than blackcurrant juice (P=0.019). CONCLUSIONS Caloric and nutrient content significantly affected gastric emptying times. A high-calorie fruit juice (mango) exhibited delayed emptying times compared with a low-calorie fruit juice (blackcurrant). CLINICAL TRIAL REGISTRATION ISRCTN17147574.
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Affiliation(s)
- Mustafa Ali
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Ahmed Uslu
- Department of Anaesthesia and Intensive Care, Başkent University Ankara Hospital, Ankara, Turkey
| | - Lars Bodin
- Uppsala University Hospital, Uppsala, Sweden
| | - Hanna Andersson
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Ali-Reza Modiri
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Peter Frykholm
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
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Daly S, Mohamed O, Loughrey J, Kearsley R, Drew T. 'Sip 'til Send': a prospective study of the effect of a liberal fluid fasting policy on patient reported and haemodynamic variables at elective caesarean delivery. Int J Obstet Anesth 2024; 57:103956. [PMID: 38030525 DOI: 10.1016/j.ijoa.2023.103956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/16/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023]
Affiliation(s)
- S Daly
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - O Mohamed
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - J Loughrey
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - R Kearsley
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - T Drew
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland.
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22
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Lyons C, El-Boghdadly K. Point-of-care gastric ultrasound: food for thought. Anaesthesia 2024; 79:123-127. [PMID: 38017691 DOI: 10.1111/anae.16190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Affiliation(s)
- C Lyons
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
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23
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Harnett C, Connors J, Kelly S, Tan T, Howle R. Evaluation of the 'Sip Til Send' regimen before elective caesarean delivery using bedside gastric ultrasound: A paired cohort pragmatic study. Eur J Anaesthesiol 2024; 41:129-135. [PMID: 37982593 DOI: 10.1097/eja.0000000000001926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Pre-operative fasting is routinely advocated to avoid pulmonary aspiration. The European Society of Anaesthesiology and Intensive Care (ESAIC) recommends a fasting period of 2 h for liquids before surgery. Liberal drinking policies such as the 'Sip Til Send' are a suggested alternative to maintain hydration before surgery. OBJECTIVES To compare residual gastric volumes in fully fasted nonlabouring parturients before elective caesarean delivery with the 'Sip Til Send' with water liberal drinking protocol. Our hypothesis was the 'Sip Til Send' would be noninferior to standard fasting at minimising the residual gastric volume immediately before surgery. DESIGN A paired cohort prospective observational pragmatic study using gastric ultrasound, analysed by an operator blinded to the fasting status of each scan. SETTING A tertiary maternity hospital in Dublin, Ireland. The study was conducted between January and June 2023. PARTICIPANTS Pregnant women about to undergo elective caesarean delivery who had followed ESAIC fasting guidelines before admission. INTERVENTIONS Each participant underwent two pairs (semi-recumbent and the semi-recumbent right lateral positions) of standardised ultrasound examinations of the gastric antrum: the order of these scans was randomised. The first pair of scans occurred on admission before the 'Sip Til Send' protocol commenced, the other pair just before spinal anaesthesia for caesarean delivery, after a variable time following the 'Sip Til Send' protocol. MAIN OUTCOME MEASURE The primary outcome was the difference in antral cross-sectional area (CSA) between the fully fasted women on admission and the same women after following the 'Sip Til Send' protocol until just before spinal anaesthesia. RESULTS Fifty-eight women were randomised for the study: 55 and 54 scans in the semi-recumbent position on admission, and 55 and 54 scans in the right lateral position just before spinal anaesthesia. The mean differences (95% CI) in CSA in the semi-recumbent and RL positions were 0.07 (-0.39 to 0.53) cm 2 and 0.04 (-0.60 to 0.68) cm 2 , respectively. Since the of 95% CIs did not cross the predefined noninferiority margin of 0.88 cm 2 , 'Sip Til Send' was noninferior to fully fasting in in terms of the antral CSA. CONCLUSION The 'Sip Til Send' protocol of liberal hydration with water was noninferior to standard fasting prior to elective caesarean delivery. TRIAL REGISTRY NUMBER NCT05783427 ClinicalTrials.gov.
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Affiliation(s)
- Colleen Harnett
- From the Coombe Hospital, Dublin, Ireland (CH, JC, SK, TT, RH)
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Hurtado Y, Hernández OA, De Leon DPA, Duque G. Challenges in Delivering Effective Care for Older Persons with Fragility Fractures. Clin Interv Aging 2024; 19:133-140. [PMID: 38283764 PMCID: PMC10822128 DOI: 10.2147/cia.s433999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
Fragility fractures occur because of low-impact trauma or even spontaneously in individuals with osteoporosis. Caring for older persons with fragility fractures can present several challenges due to the unique needs and vulnerabilities of this population. Older individuals commonly have multiple medical conditions, such as osteoporosis, arthritis, cardiovascular diseases, and diabetes. These comorbidities can complicate fracture management and increase the risk of complications. Fracture repair through surgery may be more complex in older patients due to poor bone quality, decreased tissue elasticity, and higher chances of anesthesia complications. In addition, mobility and functional limitations post-fracture are highly prevalent in this population, affecting their independence and increasing their risk of institutionalization. Addressing these challenges requires a multidisciplinary approach involving orthopedic surgeons, geriatricians, physical and rehabilitation physicians, physiotherapists, occupational therapists, dieticians, social workers, and caregivers. Preventive measures, such as fall prevention strategies and osteoporosis management, can also play a vital role in reducing the incidence of fragility fractures in older persons.
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Affiliation(s)
- Yesid Hurtado
- Division of Endocrinology, Hospital San José, Bogotá, Colombia
| | | | | | - Gustavo Duque
- Bone, Muscle & Geroscience Research Group, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
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[Clinical practice guidelines for bronchoalveolar lavage in Chinese children (2024)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:1-13. [PMID: 38269452 PMCID: PMC10817737 DOI: 10.7499/j.issn.1008-8830.2308072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/11/2023] [Indexed: 01/26/2024]
Abstract
Bronchoalveolar lavage (BAL) has become an important technique in the diagnosis and treatment of respiratory diseases in children. In order to standardize the clinical application of BAL in children, the Branch of Pediatric Critical Care Physicians of Chinese Medical Association, in collaboration with other institutions, has developed the "Clinical practice guidelines for bronchoalveolar lavage in Chinese children (2024)" based on the principles of the World Health Organization guidelines and the formulation/revision principles of the Chinese clinical practice guidelines (2022 edition). This guideline provides 30 recommendations to guide the operational procedures of BAL in children.
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Dobson GR, Chau A. Special announcement: Guidelines to the Practice of Anesthesia-Revised Edition 2024. Can J Anaesth 2024; 71:1-7. [PMID: 38253967 DOI: 10.1007/s12630-023-02667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 01/24/2024] Open
Affiliation(s)
- Gregory R Dobson
- Clinical Practice Guidelines Committee, Canadian Anesthesiologists' Society, Toronto, ON, Canada.
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
- Canadian Anesthesiologists' Society, 455 Danforth Avenue, Unit 469, Toronto, ON, M4K 1P1, Canada.
| | - Anthony Chau
- Clinical Practice Guidelines Committee, Canadian Anesthesiologists' Society, Toronto, ON, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Anesthesia, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
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Wiles MD, Macdonald A. The effect of a 'Sip til Send' policy on patient satisfaction: a quality improvement project. Anaesth Rep 2024; 12:e12271. [PMID: 38187936 PMCID: PMC10771015 DOI: 10.1002/anr3.12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/09/2024] Open
Abstract
Patients often are nil by mouth for prolonged periods pre-operatively, which is associated with adverse effects including discomfort, anxiety, thirst and nausea. As a result, several hospitals have introduced a more liberal regimen of pre-operative drinking, with patients encouraged to sip small volumes of water until transfer to the operating theatre ('Sip til Send'). The impact of 'Sip til Send' on patient satisfaction is still to be determined. We hypothesised that the introduction of a 'Sip til Send' policy would increase patient's satisfaction with their pre-operative fluid management regimen. We conducted a staged implementation of a 'Sip til Send' quality improvement initiative in two campuses of a large tertiary teaching hospital. This involved a targeted education and implementation programme that was refined and delivered through 'plan, do, study and act' cycles. Patient satisfaction with their pre-operative fluid management was measured by rating the statement "I am happy with the management of pre-operative drinking", against a five-point Likert scale (0, strongly disagree; 1, disagree; 2, neutral; 3, agree; and 4, strongly agree). Patient satisfaction with pre-operative fluid management was high at baseline, with pooled data for both campuses showing a median (IQR [range]) satisfaction score of 4 (3-4 [1-4]). After the implementation of 'Sip til Send', this improved to a median (IQR [range]) satisfaction score of 4 (4-4 [2-4]) (p < 0.001). The introduction of a 'Sip til Send' policy resulted in an increase in patient satisfaction. Key factors in successful implementation included the provision of a clear explanation of the underlying rationale to patients, nursing and anaesthetic staff, and establishing the policy as the default position for all elective patients.
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Affiliation(s)
- M. D. Wiles
- Department of Critical CareSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
- Centre for Applied Health & Social Care Research (CARe)Sheffield Hallam UniversitySheffieldUK
- University of SheffieldSheffieldUK
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Schmitz A, Kuhn F, Hofmann J, Habre W, Erb T, Preuss M, Wendel-Garcia PD, Weiss M, Schmidt AR. Incidence of adverse respiratory events after adjustment of clear fluid fasting recommendations to 1 h: a prospective, observational, multi-institutional cohort study. Br J Anaesth 2024; 132:66-75. [PMID: 37953199 DOI: 10.1016/j.bja.2023.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/22/2023] [Accepted: 10/07/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Preoperative fasting reduces the risk of pulmonary aspiration during anaesthesia, and 2-h fasting for clear fluids has commonly been recommended. Based on recent evidence of shorter fasting times being safe, the Swiss Society of Paediatric Anaesthesia began recommending 1-h fasting for clear fluids in 2018. This prospective, observational, multi-institutional cohort study aimed to investigate the incidence of adverse respiratory events after implementing the new national recommendation. METHODS Eleven Swiss anaesthesia institutions joined this cohort study and included patients aged 0-15 yr undergoing anaesthesia for elective procedures after implementation of the 1-h fasting instruction. The primary outcome was the perioperative (defined as the time from anaesthesia induction to emergence) incidence of pulmonary aspiration, gastric regurgitation, and vomiting. Data are presented as median (inter-quartile range; minimum-maximum) or count (percentage). RESULTS From June 2019 to July 2021, 22 766 anaesthetics were recorded with pulmonary aspiration occurring in 25 (0.11%), gastric regurgitation in 34 (0.15%), and vomiting in 85 (0.37%) cases. No major morbidity or mortality was associated with pulmonary aspiration. Subgroup analysis by effective fasting times (<2 h [n=7306] vs ≥2 h [n=14 660]) showed no significant difference for pulmonary aspiration between these two groups (9 [0.12%] vs 16 [0.11%], P=0.678). Median effective fasting time for clear fluids was 157 [104-314; 2-2385] min. CONCLUSIONS Implementing a national recommendation of 1-h clear fluid fasting was not associated with a higher incidence of pulmonary aspiration compared with previously reported data.
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Affiliation(s)
- Achim Schmitz
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabian Kuhn
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Hofmann
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Walid Habre
- Unit for Anaesthesiological Investigation, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas Erb
- Department of Anaesthesia, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Preuss
- General Secretary of Association of Swiss Office Based Anaesthesiologists (ASOBA), Joint Office for Outpatient Anesthesia (AGPA) Baden-Dättwil, Switzerland
| | - Pedro D Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Markus Weiss
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander R Schmidt
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University - School of Medicine, Stanford, CA, USA.
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Zou S, Guo L, Xu C, Liu T, Li L, Pan S, Qi D. Effect of chewing gum of different weights before surgery on sore throat after total thyroidectomy: A randomized controlled trial. World J Surg 2024; 48:130-137. [PMID: 38284756 DOI: 10.1002/wjs.12025] [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: 10/12/2023] [Revised: 10/21/2023] [Accepted: 10/31/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Postoperative sore throat (POST) is a common postoperative complication. COMPLICATION Chewing gum can inhibit the growth of oral bacteria, cleanse, and lubricate the oral cavity, which can help reduce postoperative sore throat. We hypothesize that chewing gum before surgery could relieve POST. METHODS Patients planned to undergo total thyroidectomy under general anesthesia with tracheal intubation were randomized to swallow saliva twice or chew 1.4 g/2.8 g of gum for 2 minutes before surgery. A standard anesthesia protocol was performed. The numerical rating scale scores of POST at 1, 24, and 48 h after surgery were collected. The primary outcome was the incidence of moderate/severe POST (numerical rating scale score >3) within 48 h. RESULTS Data from 148 patients (control group, n = 50; 1.4 g group, n = 48; and 2.8 g group, n = 50) were included in the analysis. Within 48 h, there was a significant difference among the three groups in the incidence of moderate/severe POST (control group: 74% vs. 1.4 g group: 65% vs. 2.8 g group: 50%. P = 0.04). The 2.8 g group had less incidence of moderate/severe POST than the control group (Odds Ratio = 0.351 95% Confidence Interval: (0.152 and 0.814) P = 0.02). CONCLUSION Chewing 2.8 g gum before total thyroidectomy can reduce the incidence of moderate/severe POST within 48 h after surgery.
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Affiliation(s)
- Shiya Zou
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, China
| | - Lulu Guo
- Department of Intensive Care Unit, Xuzhou Center Hospital, Xuzhou, China
| | - Chao Xu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianyu Liu
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Lei Li
- Suzhou Wujiang District Center for Disease Control and Prevention, Suzhou, China
| | - Shoudong Pan
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, China
| | - Dunyi Qi
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Peking, China
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30
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Rousset J, Derely J, LE Guen M, Soued M, Fischler M, Mercier FJ, Vallee A, LE Gouez A. An observational study of gastric content in women scheduled for cesarean section or operative hysteroscopy. Minerva Anestesiol 2023; 89:1065-1073. [PMID: 37768703 DOI: 10.23736/s0375-9393.23.17434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND The estimation of gastric content in third trimester pregnant women has already been studied, conclusions remain contradictory. The aim of this study was to compare gastric content in pregnant and non-pregnant women using gastric ultrasound. We performed an observational two-center study of women scheduled for a cesarean section (CS group) and of non-pregnant women scheduled for hysteroscopy (HS group). METHODS Ultrasound evaluation was performed before surgery with measurement of antral cross-sectional area (CSA) in the semi-recumbent position (SRP), primary outcome, and in the right lateral position (RLD). Gastric fluid volume (GFV) was calculated. Results are expressed as medians (25th and 75th percentiles). Perlas Score was evaluated and expressed as number (percentage). RESULTS Sixty patients in the CS group and 64 in the HS group were analyzed. Antral CSA (SRP) was greater in the CS group (350 mm2 [236-415] vs. 247 mm2 [180-318]; P=0.001). Antral CSA (RLD) was also significantly greater in the CS group (P=0.027). GFV was not different between groups whether expressed in absolute value (P=0.516) or relative to weight (P=0.946) mL.kg-1. Perlas Score repartition was similar in both groups (P=0.860). Kappa coefficients of concordance between CSA, GFV and Perlas Score were slight or at best fair. CONCLUSIONS Our study confirmed that antral CSA is increased among pregnant women and outlined that antral CSA should not be used alone in the decision-making process especially when the results of indicators (antral CSA, GFV, and Perlas Grading Score) are discordant.
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Affiliation(s)
- Julien Rousset
- Service of Anesthesiology, Department of Anesthesiology, Foch Hospital, Suresnes, France -
- Paris-Saclay University, Gif-sur-Yvette, France -
| | - Jean Derely
- Paris-Saclay University, Gif-sur-Yvette, France
- Department of Anesthesiology and Intensive Care, Antoine-Béclère Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Clamart, France
| | - Morgan LE Guen
- Service of Anesthesiology, Department of Anesthesiology, Foch Hospital, Suresnes, France
- Paris-Saclay University, Gif-sur-Yvette, France
| | - Mickaël Soued
- Paris-Saclay University, Gif-sur-Yvette, France
- Department of Anesthesiology and Intensive Care, Antoine-Béclère Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Clamart, France
| | - Marc Fischler
- Service of Anesthesiology, Department of Anesthesiology, Foch Hospital, Suresnes, France
- Paris-Saclay University, Gif-sur-Yvette, France
| | - Frédéric J Mercier
- Paris-Saclay University, Gif-sur-Yvette, France
- Department of Anesthesiology and Intensive Care, Antoine-Béclère Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Clamart, France
| | - Alexandre Vallee
- Department of Epidemiology, Data, and Biostatistics, Delegation of Clinical Research and Innovation, Foch Hospital, Suresnes, France
| | - Agnes LE Gouez
- Paris-Saclay University, Gif-sur-Yvette, France
- Department of Anesthesiology and Intensive Care, Antoine-Béclère Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Clamart, France
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Azem K, Orbach-Zinger S, Heesen P, Finkelstein A, Eidelman LA, Shufaro Y, Arzola C. The effect of preoperative anxiety and ovarian stimulation on gastric antrum size: a prospective observational study. J Psychosom Obstet Gynaecol 2023; 44:2170226. [PMID: 36774546 DOI: 10.1080/0167482x.2023.2170226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Pulmonary aspiration is a potentially lethal perioperative complication related to gastric size and contents. Several perioperative factors are believed to increase gastric size, while others are less studied. This prospective observational study aimed to investigate the effect of preoperative anxiety and hormone-induced ovarian stimulation on gastric size examined by gastric ultrasound. We recruited 49 female patients undergoing hormone-induced ovarian stimulation and oocyte retrieval for in vitro fertilization at Rabin Medical Centre, Petah Tikva, Israel. Preoperatively, women ranked their anxiety level using a verbal numeric anxiety score (VNS). In addition, we recorded the extent of ovarian stimulation and measured the antral cross-sectional area (CSA) using gastric ultrasound. There was no substantial correlation between preoperative VNS anxiety and antral CSA (p = .697). Moreover, the number of follicles, blood estradiol, and progesterone levels did not correlate with antral CSA (p = .590, p = .104, and p = .511, respectively). In conclusion, neither preoperative anxiety nor extensive ovarian stimulation affects gastric size in fasting healthy patients. However, further studies are warranted in this area to define these findings better. Trial registration: Clinicaltrials.gov, identifier: NCT04833530.
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Affiliation(s)
- Karam Azem
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Orbach-Zinger
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philip Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Arthur Finkelstein
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid A Eidelman
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Shufaro
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Cristian Arzola
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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Tian QF, Zhao AX, Du N, Wang ZJ, Ma LL, Men FL. General anesthesia with endotracheal intubation ensures the quick removal of magnetic foreign bodies: A case report. World J Gastrointest Endosc 2023; 15:676-680. [DOI: 10.4253/wjge.v15.i11.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The incidence of ingestion of magnetic foreign bodies in the gastrointestinal tract has been increasing year by year. Due to their strong magnetic attraction, if multiple gastrointestinal foreign bodies enter the small intestine, it can lead to serious complications such as intestinal perforation, necrosis, torsion, and bleeding. Severe cases require surgical intervention.
CASE SUMMARY We report a 6-year-old child who accidentally swallowed multiple magnetic balls. Under timely and safe anesthesia, the magnetic balls were quickly removed through gastroscopy before entering the small intestine.
CONCLUSION General anesthesia with endotracheal intubation can ensure full anesthesia under the condition of fasting for less than 6 h. In order to prevent magnetic foreign bodies from entering the small intestine, timely and effective measures must be taken to remove the foreign bodies.
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Affiliation(s)
- Qi-Fei Tian
- Department of Gastroenterology, Dongying People's Hospital, Dongying 257091, Shandong Province, China
| | - Ai-Xiang Zhao
- Department of Anesthesiology, Dongying People's Hospital, Dongying 257091, Shandong Province, China
| | - Ni Du
- Department of Gastroenterology, Dongying People's Hospital, Dongying 257091, Shandong Province, China
| | - Zeng-Juan Wang
- Department of Anesthesiology, Dongying People's Hospital, Dongying 257091, Shandong Province, China
| | - Ling-Ling Ma
- Department of Gastroenterology, Dongying People's Hospital, Dongying 257091, Shandong Province, China
| | - Fang-Li Men
- Department of Gastroenterology, Dongying People's Hospital, Dongying 257091, Shandong Province, China
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Sparling JL, Yeh DD. Hungry for Change: How Best to Implement and Sustain Reduced Fasting Times in Hospitalized Surgical Patients? Jt Comm J Qual Patient Saf 2023; 49:579-580. [PMID: 37516602 DOI: 10.1016/j.jcjq.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
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Sparling JL, Nagrebetsky A, Mueller AL, Albanese ML, Williams GW, Wischmeyer PE, Rice TW, Low YH. Preprocedural fasting policies for patients receiving tube feeding: A national survey. JPEN J Parenter Enteral Nutr 2023; 47:1011-1020. [PMID: 37543845 DOI: 10.1002/jpen.2556] [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: 03/24/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Patients who are critically ill frequently accrue substantial nutrition deficits due to multiple episodes of prolonged fasting prior to procedures. Existing literature suggests that, for most patients receiving tube feeding, the aspiration risk is low. Yet, national and international guidelines do not address fasting times for tube feeding, promoting uncertainty regarding optimal preprocedural fasting practice. We aimed to characterize current institutional fasting practices in the United States for patients with and without a secure airway, with variable types of enteral access, for representative surgical procedures. METHODS The survey was distributed to a purposive sample of academic institutions in the United States. Reponses were reported as restrictive (6-8 h preprocedurally) or permissive (<6 h or continued intraprocedurally) feeding policies. Differences between level 1 trauma centers and others, and between burn centers and others, were evaluated. RESULTS The response rate was 40.3% (56 of 139 institutions). Responses revealed a wide variability with respect to current practices, with more permissive policies reported in patients with secure airways. In patients with a secure airway, Level 1 trauma centers were significantly more likely to have permissive fasting policies for patients undergoing an extremity incision and drainage for each type of feeding tube surveyed. CONCLUSIONS Current hospital policies for preprocedural fasting in patients receiving tube feeds are conflicting and are frequently more permissive than guidelines for healthy patients receiving oral nutrition. Prospective research is needed to establish the safety and clinical effects of various fasting practices in tube-fed patients.
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Affiliation(s)
- Jamie L Sparling
- Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexander Nagrebetsky
- Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ariel L Mueller
- Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marissa L Albanese
- Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - George W Williams
- Department of Anesthesiology, Department of Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Paul E Wischmeyer
- Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Todd W Rice
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ying H Low
- Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Jolley A, Jin W, Mansour K, Moore D, Douglas N, Loveday BPT. Reducing Preoperative Fasting Through Technology and Education in an Acute General Surgical Adult Cohort. Jt Comm J Qual Patient Saf 2023; 49:584-591. [PMID: 37419782 DOI: 10.1016/j.jcjq.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Despite widespread support for reduced fasting protocols prior to anesthesia, the traditional "fast from midnight" (FFMN) remains widely employed. This study implemented a pilot preoperative fasting reduction program for patients booked for acute surgery in the Department of General Surgery at a busy metropolitan tertiary hospital, including use of an electronic health record (EHR)-based solution, aiming to measure effect on fasting times and use of intravenous fluid (IVF). METHODS A pilot program was implemented in August 2021 in the Emergency General Surgery (EGS) unit at the Royal Melbourne Hospital, Australia. This included a new smart phrase within the EHR (EU2WU6: Eat until 2, drink water until 6) and an education campaign. Adult patients who underwent preoperative fasting between September 1 and December 31, 2021, were screened. Uptake of the protocol was recorded. Further, total fasting times (TFT) and IVF use were recorded. Potential impact with varying levels of protocol uptake was modeled. RESULTS Uptake of EU2WU6 increased from 0% to 80%. TFT and total time on IVF (TT-IVF) were lower using EU2WU6 (TFT 7 hours vs. 13 hours, p < 0.001; TT-IVF 3 hours vs. 8 hours, p < 0.001). Proportion of patients requiring fluid overnight when using EU2WU6 was lower (18/45 vs. 34/50, p = 0.0062). Hospitalwide yearly savings, with 100% application of EU2WU6, were projected at 2,050 bags of IVF (at a cost savings of A$2,296), 10,251 minutes for physicians, and 20,502 minutes for nurses. CONCLUSION The pilot preoperative fasting reduction program successfully reduced disparity between evidence and clinical practice.
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36
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Perera H, Wusu A, Mohammad A, Qulaghassi MZ, Abdulkarim A. An Audit on the Pre-operative Fasting Time of Trauma-List Orthopaedic Patients at a District General Hospital in Chichester, United Kingdom. Cureus 2023; 15:e48327. [PMID: 38024025 PMCID: PMC10653621 DOI: 10.7759/cureus.48327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Pre-operative fasting of patients awaiting non-emergency surgeries has been a common practice to minimise the risk of vomiting and aspiration at the time of induction of anaesthesia. Current standard guidelines recommend that this fasting time be limited to two hours for clear fluids and six hours for solids and semi-solids, as prolonged fasting has been shown to be harmful to the patient. METHODS A descriptive cross-sectional study of the fasting times of all adult trauma orthopaedic patients who were operated on under anaesthesia between June 1 and 30, 2023. Fifty patients who met the inclusion criteria were included in the study. RESULTS The minimum and maximum fasting times observed for solids and semi-solids were 9 and 24 hours, respectively. The mean fasting time for solids and semi-solids was 15.8 hours. The minimum and maximum fasting times observed for clear fluids were 2 and 20 hours, respectively. The mean fasting time for clear fluids was 10.5 hours. Elderly patients accounted for a significant portion of the patients, with 64% (n=32) being above the age of 70 years. CONCLUSION A significant disparity was noted between the current fasting practices and the recommended standards set out by the Royal College of Nursing, the Association of Anaesthetists of Great Britain and Ireland, the European Society of Anaesthesiology, and the American Society of Anaesthesiologists. The knowledge of pre-operative fasting among the orthopaedic team doctors and the ward nursing staff was found to be inadequate.
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Affiliation(s)
- Hector Perera
- General Surgery, Royal Sussex County Hospital, Brighton, GBR
| | - Adedoyin Wusu
- Trauma and Orthopaedics, St Richard's Hospital, Chichester, GBR
| | | | | | - Ali Abdulkarim
- Trauma and Orthopaedics, St Richard's Hospital, Chichester, GBR
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Flore G, Deledda A, Fosci M, Lombardo M, Moroni E, Pintus S, Velluzzi F, Fantola G. Perioperative Nutritional Management in Enhanced Recovery after Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6899. [PMID: 37835169 PMCID: PMC10573058 DOI: 10.3390/ijerph20196899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
Obesity is a crucial health problem because it leads to several chronic diseases with an increased risk of mortality and it is very hard to reverse with conventional treatment including changes in lifestyle and pharmacotherapy. Bariatric surgery (BS), comprising a range of various surgical procedures that modify the digestive tract favouring weight loss, is considered the most effective medical intervention to counteract severe obesity, especially in the presence of metabolic comorbidities. The Enhanced Recovery After Bariatric Surgery (ERABS) protocols include a set of recommendations that can be applied before and after BS. The primary aim of ERABS protocols is to facilitate and expedite the recovery process while enhancing the overall effectiveness of bariatric procedures. ERABS protocols include indications about preoperative fasting as well as on how to feed the patient on the day of the intervention, and how to nourish and hydrate in the days after BS. This narrative review examines the application, the feasibility and the efficacy of ERABS protocols applied to the field of nutrition. We found that ERABS protocols, in particular not fasting the patient before the surgery, are often not correctly applied for reasons that are not evidence-based. Furthermore, we identified some gaps in the research about some practises that could be implemented in the presence of additional evidence.
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Affiliation(s)
- Giovanna Flore
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Andrea Deledda
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Michele Fosci
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166 Rome, Italy;
| | - Enrico Moroni
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
| | - Stefano Pintus
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
| | - Fernanda Velluzzi
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Giovanni Fantola
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
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Greco M, Calgaro G, Cecconi M. Management of hospital admission, patient information and education, and immediate preoperative care. Saudi J Anaesth 2023; 17:517-522. [PMID: 37779563 PMCID: PMC10540991 DOI: 10.4103/sja.sja_592_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 10/03/2023] Open
Abstract
An increasing proportion of surgical procedures involves elderly and frail patients in high-income countries, leading to an increased risk of postoperative complications. Complications significantly impact patient outcomes and costs, due to prolonged hospitalization and loss of autonomy. Consequently, it is crucial to evaluate preoperative functional status in older patients, to tailor the perioperative plan, and evaluate risks. The hospital environment often exacerbates cognitive impairments in elderly and frail patients, also increasing the risk of infection, falls, and malnutrition. Thus, it is essential to work on dedicated pathways to reduce hospital readmissions and favor discharges to a familiar environment. In this context, the use of wearable devices and telehealth has been promising. Telemedicine can be used for preoperative evaluations and to allow earlier discharges with continuous monitoring. Wearable devices can track patient vitals both preoperatively and postoperatively. Preoperative education of patient and caregivers can improve postoperative outcomes and is favored by technology-based approach that increases flexibility and reduce the need for in-person clinical visits and associated travel; moreover, such approaches empower patients with a greater understanding of possible risks, moving toward shared decision-making principles. Finally, caregivers play an integral role in patient improvement, for example, in the prevention of delirium. Hence, their inclusion in the care process is not only advantageous but essential to improve perioperative outcomes in this population.
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Affiliation(s)
- Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Giulio Calgaro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
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Wang S, Zhang Y, Ma X, Lin L, Tian L. Nursing measures in the fast-track surgery on negative emotions in breast cancer patients: A meta-analysis. Medicine (Baltimore) 2023; 102:e34896. [PMID: 37746946 PMCID: PMC10519519 DOI: 10.1097/md.0000000000034896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND To critically evaluate the effects of different nursing measures based on the concept of fast-track surgery (FTS) on the negative emotions of patients with breast cancer. METHODS A systematic search of 8 databases, namely PubMed, Cochrane Library, Embase, Psycho info, China national knowledge infrastructure, Wanfang, China science and technology journal database, and China biomedical literature database, was performed to find randomized controlled trials from inception to April 2023. Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed form. All analyses were performed with Review Manager 5.3. RESULTS Ten studies were included in the systematic review, with a total of 830 patients (FTS group: 415; control group: 415). The results showed that different nursing measures based on the concept of FTS could significantly reduce anxiety (MD = -1.74, 95% confidence intervals [-2.41, -1.08], P < .00001) and depression (MD = -1.98, 95% confidence intervals [-2.44, -1.51], P < .00001) in patients after modified breast cancer surgery compared with the control group. CONCLUSIONS Based on the concept of FTS, the nursing measures such as reducing preoperative fasting time, posture management, preventive analgesia, and early functional exercise can effectively reduce the anxiety and depression of patients during the perioperative period.
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Affiliation(s)
- Shaotong Wang
- The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China
| | - Yueyue Zhang
- The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China
| | - Xiaomin Ma
- The First People’s Hospital of Kunshan, Suzhou, People’s Republic of China
| | - Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China
| | - Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China
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Tan SHS, Elshikhawoda MSM, Jararaa S, Cheung CP, Jararah H. Preoperative Snack Prescription: A Single-Centre Experience in Optimising Preoperative Fasting Time and Enhancing Guideline Adherence. Cureus 2023; 15:e46271. [PMID: 37908906 PMCID: PMC10615353 DOI: 10.7759/cureus.46271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
Objectives Preoperative fasting plays a pivotal role in adequately preparing patients for anaesthesia and surgical procedures. However, it is imperative to consider not only the medical aspects but also patients' overall comfort, as this can significantly contribute to improved surgical outcome. The primary objective of this quality improvement project (QIP) is to provide healthcare professionals, including anaesthetists, surgeons, nurses, and stakeholders with information regarding insights required to embrace the concept of preoperative snack prescription as a strategy for enhancing patient-centred care. Methods This QIP was conducted in the vascular surgery department of a district general hospital in Wales, United Kingdom. A prospective analysis was conducted in two cycles, i.e., the pre-intervention group (PrIG) and post-intervention group (PoIG), with preoperative snacks such as biscuits, chips, or cakes, being prescribed to the PoIG. A total of 40 patients who met the inclusion criteria were enrolled in this study, with 20 patients participating in each cycle. The timing of preoperative meals, i.e., the closest preoperative breakfast, lunch, or dinner, preoperative snacks (for the PoIG), anaesthesia commencement, and surgical commencement were collected. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), in conjunction with Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). Results In our QIP, the PrIG and PoIG comprised 40% (8 out of 20) and 35% (7 out of 20) female patients, respectively, with mean ages of 74 years (range, 61-86 years) and 61.3 years (range, 36-81 years). Within the PrIG, the mean duration from the preoperative meal to anaesthesia and surgery commencement was 17.8 hours (range, 14.6-22.5 hours) and 18.5 hours (range, 16.0-23.3 hours), respectively. In the PoIG, following the initiation of preoperative snack prescription, the mean time intervals between preoperative snack prescription and anaesthesia and surgery commencement were 10.9 hours (range, 6.5-16.0 hours) and 12.0 hours (range, 7.5-16.5 hours), respectively. Conclusions In summary, our QIP has successfully integrated preoperative snack prescription into the local hospital's preoperative care policy, prioritising the balance between patient safety and comfort. Based on our single-centre experience, we observed a significant reduction in the time interval between preoperative fasting and the initiation of anaesthesia, decreasing from 18.3 hours to 10.9 hours post-implementation of preoperative snacks. This QIP holds relevance for healthcare professionals as it underscores the benefits of shorter fasting periods, which contribute to heightened patient satisfaction and comfort.
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Affiliation(s)
- Steven H S Tan
- Trauma and Orthopaedics, University Hospital Llandough, Penarth, GBR
- Vascular Surgery, Glan Clwyd Hospital, Rhyl, GBR
| | | | | | - Che-Pin Cheung
- Trauma and Orthopaedics, Bronglais Hospital, Aberystwyth, GBR
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Chen X, Chang C, Yuan X, Yang J, Li K. Efficacy and safety of preoperative chewing gum for undergoing elective surgery: A meta-analysis of randomised controlled trials. J Clin Nurs 2023; 32:4295-4310. [PMID: 36691328 DOI: 10.1111/jocn.16604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/07/2022] [Accepted: 12/05/2022] [Indexed: 01/25/2023]
Abstract
AIMS AND OBJECTIVES This meta-analysis aimed to investigate the safety and feasibility of preoperative chewing gum in adult patients undergoing elective surgery. BACKGROUND Postoperative chewing gum has been shown to be safe and effective for most surgeries, while the safety and efficacy of preoperative chewing gum are still controversial. DESIGN A meta-analysis of randomised controlled trials was performed. NO PATIENT OR PUBLIC CONTRIBUTION This was a meta-analysis involving no people or animals. METHODS The literature search was performed in 9 databases from inception to July 2022. Randomised controlled trials that compared the safety and efficacy of preoperative chewing gum and preoperative chewing no gum in adult patients undergoing elective surgery were included. The study was reported in compliance with PRISMA statement. TRIAL REGISTRATION PROSPERO CRD42022330223. RESULTS Fourteen trials involving 1433 adult patients who undergo elective surgery were pooled in this meta-analysis. The results showed that preoperative chewing gum group resulted in no significant difference in gastric pH (p = .13) and gastric fluid volume (p = .25) compared with non-gum-chewing group. In comparison with the non-gum-chewing group, the gum-chewing group was associated with shorter preoperative thirst score (p = .02), lower incidence of postoperative nausea (p = .0004), lower incidence of postoperative sore throat, lower incidence of postoperative hoarseness, lower postoperative pain score, shorter first postoperative anal exhaust time (p < .00001), shorter first postoperative defecation time (p < .00001) and shorter hospital days (p = .02). CONCLUSIONS Preoperative chewing gum was associated with lower discomforts and complication rates, without increasing gastric pH and gastric fluid volume. This strategy may be an innovative, feasible and safe choice for elective surgery in adults. RELEVANCE TO CLINICAL PRACTICE This study's results could be used as an evidence for the implementation of preoperative chewing gum in perioperative care for adult patients undergoing elective surgery.
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Affiliation(s)
- Xinrong Chen
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Chengting Chang
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xingzhu Yuan
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ka Li
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Bloc S, Alfonsi P, Belbachir A, Beaussier M, Bouvet L, Campard S, Campion S, Cazenave L, Diemunsch P, Di Maria S, Dufour G, Fabri S, Fletcher D, Garnier M, Godier A, Grillo P, Huet O, Joosten A, Lasocki S, Le Guen M, Le Saché F, Macquer I, Marquis C, de Montblanc J, Maurice-Szamburski A, Nguyen YL, Ruscio L, Zieleskiewicz L, Caillard A, Weiss E. Guidelines on perioperative optimization protocol for the adult patient 2023. Anaesth Crit Care Pain Med 2023; 42:101264. [PMID: 37295649 DOI: 10.1016/j.accpm.2023.101264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The French Society of Anesthesiology and Intensive Care Medicine [Société Française d'Anesthésie et de Réanimation (SFAR)] aimed at providing guidelines for the implementation of perioperative optimization programs. DESIGN A consensus committee of 29 experts from the SFAR was convened. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Four fields were defined: 1) Generalities on perioperative optimization programs; 2) Preoperative measures; 3) Intraoperative measures and; 4) Postoperative measures. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. The recommendations were formulated according to the GRADE® methodology and then voted on by all the experts according to the GRADE grid method. As the GRADE® methodology could have been fully applied for the vast majority of questions, the recommendations were formulated using a "formalized expert recommendations" format. RESULTS The experts' work on synthesis and application of the GRADE® method resulted in 30 recommendations. Among the formalized recommendations, 19 were found to have a high level of evidence (GRADE 1±) and ten a low level of evidence (GRADE 2±). For one recommendation, the GRADE methodology could not be fully applied, resulting in an expert opinion. Two questions did not find any response in the literature. After two rounds of rating and several amendments, strong agreement was reached for all the recommendations. CONCLUSIONS Strong agreement among the experts was obtained to provide 30 recommendations for the elaboration and/or implementation of perioperative optimization programs in the highest number of surgical fields.
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Affiliation(s)
- Sébastien Bloc
- Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, France; Department of Anesthesiology, Clinique Drouot Sport, Paris, France.
| | - Pascal Alfonsi
- Department of Anesthesia, University of Paris Descartes, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, F-75674 Paris Cedex 14, France
| | - Anissa Belbachir
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Marc Beaussier
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Sébastien Campion
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie-Réanimation, F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - Laure Cazenave
- Department of Anaesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France; Groupe Jeunes, French Society of Anaesthesia and Intensive Care Medicine (SFAR), 75016 Paris, France
| | - Pierre Diemunsch
- Unité de Réanimation Chirurgicale, Service d'Anesthésie-réanimation Chirurgicale, Pôle Anesthésie-Réanimations Chirurgicales, Samu-Smur, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Dufour
- Service d'Anesthésie-Réanimation, CHU de Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013 Paris, France
| | - Stéphanie Fabri
- Faculty of Economics, Management & Accountancy, University of Malta, Malta
| | - Dominique Fletcher
- Université de Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise-Paré, Service d'Anesthésie, 9, Avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marc Garnier
- Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France
| | - Anne Godier
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, France
| | | | - Olivier Huet
- CHU de Brest, Anesthesia and Intensive Care Unit, Brest, France
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, France
| | | | - Morgan Le Guen
- Paris Saclay University, Department of Anaesthesia and Pain Medicine, Foch Hospital, 92150 Suresnes, France
| | - Frédéric Le Saché
- Department of Anesthesiology, Clinique Drouot Sport, Paris, France; DMU DREAM Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Isabelle Macquer
- Bordeaux University Hospitals, Bordeaux, Anaesthesia and Intensive Care Medicine Department, Bordeaux, France
| | - Constance Marquis
- Clinique du Sport, Département d'Anesthésie et Réanimation, Médipole Garonne, 45 rue de Gironis - CS 13 624, 31036 Toulouse Cedex 1, France
| | - Jacques de Montblanc
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Yên-Lan Nguyen
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France
| | - Laura Ruscio
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France; INSERM U 1195, Université Paris-Saclay, Saint-Aubin, Île-de-France, France
| | - Laurent Zieleskiewicz
- Service d'Anesthésie Réanimation, Hôpital Nord, AP-HM, Marseille, Aix Marseille Université, C2VN, France
| | - Anaîs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical Care and Perioperative Medicine Department, Brest, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France
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Kotfis K, Wojciechowska A, Zimny M, Jamioł-Milc D, Szylińska A, Kwiatkowski S, Kaim K, Dołęgowska B, Stachowska E, Zukowski M, Pankowiak M, Torbé A, Wischmeyer P. Preoperative Oral Carbohydrate (CHO) Supplementation Is Beneficial for Clinical and Biochemical Outcomes in Patients Undergoing Elective Cesarean Delivery under Spinal Anaesthesia-A Randomized Controlled Trial. J Clin Med 2023; 12:4978. [PMID: 37568381 PMCID: PMC10419905 DOI: 10.3390/jcm12154978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Preoperative fasting and surgery cause metabolic stress, insulin resistance with ketosis, and postoperative nausea and vomiting (PONV). Oral carbohydrate loading strategy (CHO) improves outcomes in labor and general surgery. We aimed to compare the effectiveness of CHO with standard fasting in patients undergoing elective cesarean delivery (CD) under spinal anesthesia. METHODS A single-center, parallel, prospective randomized controlled trial (RCT) was conducted in a tertiary university obstetrics department at Pomeranian Medical University in Szczecin, Poland. Patients were randomly assigned (1:1 ratio) to the CHO group (oral carbohydrate 2 h before elective CD, n = 75) or the SF group (control-standard fasting, n = 73). The main outcome measures were incidence and severity of PONV at 6 and 24 h after CD, time to the first peristalsis, time to first bowel movement, and biochemical parameters indicating ketosis in mothers and their children. RESULTS A total of 148 adult females with singleton pregnancies undergoing elective CD under spinal anesthesia (ASA I and II) were included in the final analysis. At 24 h after CD, 8.0% from the CHO group vs. 20.55% reported three or more episodes of vomiting or dry retching as compared to patients in the SF group (p = 0.041). Preoperative CHO supplementation decreased preoperative feelings of hunger (p < 0.001) and thirst (p < 0.001). Laboratory results in the CHO group showed higher plasma pH (p = 0.001) and glucose (p < 0.001), lower F2-isoprostane in plasma (p = 0.049) and urine (p = 0.018), lower urine F2-isoprostane/creatinine ratio (p = 0.045) than in the SF group. HOMA-IR (p < 0.001) and lactate (p < 0.001) were higher in the CHO group than in the control group. CONCLUSIONS There was no significant difference in the incidence or severity of early PONV at 6 h. The incidence of vomiting or dry retching at 24 h after cesarean delivery was lower in the CHO group as compared to standard starvation, but the combined results of PONV frequency and severity on the Wengritzky scale did not differ between the two study groups. Preoperative CHO supplementation decreased preoperative feelings of hunger and thirst, enhancing the comfort of pregnant women. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04069806.
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Affiliation(s)
- Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (K.K.); (M.Z.); (M.P.)
| | - Arleta Wojciechowska
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.W.); (M.Z.); (S.K.); (A.T.)
| | - Małgorzata Zimny
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.W.); (M.Z.); (S.K.); (A.T.)
| | - Dominika Jamioł-Milc
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (D.J.-M.); (E.S.)
| | - Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland;
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.W.); (M.Z.); (S.K.); (A.T.)
| | - Karolina Kaim
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (K.K.); (M.Z.); (M.P.)
| | - Barbara Dołęgowska
- Department of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (D.J.-M.); (E.S.)
| | - Maciej Zukowski
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (K.K.); (M.Z.); (M.P.)
| | - Maria Pankowiak
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (K.K.); (M.Z.); (M.P.)
| | - Andrzej Torbé
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.W.); (M.Z.); (S.K.); (A.T.)
| | - Paul Wischmeyer
- Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, NC 27710, USA;
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Valencia A, Trujillo A, Arango F. Preoperative ultrasound evaluation of gastric contents in children one hour after ingestion of clear liquid: An observational study. Saudi J Anaesth 2023; 17:368-372. [PMID: 37601499 PMCID: PMC10435782 DOI: 10.4103/sja.sja_31_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 08/22/2023] Open
Abstract
Background Gastric ultrasound is an effective, non-invasive method to assess the nature and volume of gastric content in the pediatric population. Recently, the UK, European, and French Pediatric Anesthesia Societies recommend fast for clear fluids in children for 1 h. However, studies showing that 1 h of fasting is safe in the pediatric population are still scarce. This study aims to verify by ultrasound evaluation if 1 h of fasting for clear liquids is sufficient to have an empty stomach before anesthetic induction. Methodology Patients between 11 months and 16 years of age scheduled for elective outpatient surgery were included. A qualitative and quantitative ultrasound evaluation was performed by calculating the cross-sectional area (CSA) of the gastric antrum, 1 h after ingesting a volume of 3 mL/kg of a non-carbonated sports drink, before anesthetic induction. Results Fifty patients were included. The average CSA measured by ultrasound was 2.85 ± 1.64 cm2 with an average calculated total volume of 12.9 ± 11.06 mL. All patients had an empty stomach criterion (calculated volume ≤1.5 mL/kg) during the ultrasound evaluation, with an average of 0.40 ± 0.23 mL/kg. With the qualitative assessment of gastric volume, 19 patients (38%) were classified as grade 0, 31 patients (62%) as grade 1, and none as grade 2. Conclusion One hour of fasting after ingestion of 3 mL/kg of a non-carbonated sports drink is sufficient to meet ultrasound criteria for an empty stomach in a pediatric population undergoing elective outpatient surgery.
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Affiliation(s)
- Alejandra Valencia
- Departamento Quirúrgico, Facultad de Ciencias para la Salud, Universidad de Caldas, Caldas, Colombia
| | - Alexander Trujillo
- Departamento Quirúrgico, Facultad de Ciencias para la Salud, Universidad de Caldas, Caldas, Colombia
- Facultad de Ciencias de la Salud, Universidad de Manizales, Manizales, Colombia
- Doctorado de Ciencias de la Salud, Universidad de Caldas, Caldas, Colombia
| | - Fernando Arango
- Facultad de Ciencias de la Salud, Universidad de Manizales, Manizales, Colombia
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Hommel E, Sissoho FB, Chang K, Suthar K. Reducing the use of nil per os past midnight for inpatient diagnostic and therapeutic procedures: A quality improvement initiative. J Hosp Med 2023; 18:375-381. [PMID: 36806907 PMCID: PMC10186274 DOI: 10.1002/jhm.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/07/2023] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Pre-procedural fasting (nil per os [NPO]) is a commonly implemented protocol to prevent aspiration during certain diagnostic and therapeutic procedures. However, evidence suggests aspiration risk is quite low. Current guidelines support a reduced fasting duration before procedures necessitating anesthesia or sedation, but many health systems persist in the use of NPO past midnight. OBJECTIVE We aimed to reduce the use of NPO p MN before inpatient diagnostic and therapeutic procedures necessitating anesthesia or sedation by 50% within 6 months. DESIGN, SETTING AND PARTICIPANTS We performed a quality improvement initiative at a single academic health system in Southeast Texas. We include the experience of patients of all ages across 4 affiliated hospitals (one main academic hospital and three community satellite hospitals). INTERVENTION An interprofessional team was convened to review best practices and oversee this quality improvement initiative. Diagnostic imaging protocols previously requiring NPO were amended to reflect evidence-based fasting requirements. A pre-procedure clear liquid diet was also implemented. MAIN OUTCOME AND MEASURES We describe the steps to implementation, feasibility of implementation as described through key process measures, and the safety of implementation (balancing measures). RESULTS NPO requirements were removed from 70% of existing diagnostic imaging and therapeutic orders. After these amended protocols and the implementation of a pre-procedure clear liquid diet, we displayed an immediate 50% reduction in NPO past midnight usage. Further stakeholder engagement/education and targeted interventions reduced NPO past midnight usage to only 33% of pre-procedural diet orders. Surgery remains the most common indication for continued use of NPO. Aspiration events and procedural delays were rare.
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Affiliation(s)
- Erin Hommel
- The University of Texas Medical Branch, Department of
Medicine, Division of Geriatrics and Palliative Care, Galveston, TX
| | - Fatoumatta B. Sissoho
- The University of Texas Medical Branch, Department of
Medicine, Division of Geriatrics and Palliative Care, Galveston, TX
| | - Karen Chang
- The University of Texas Medical Branch, School of
Medicine, Galveston, TX
| | - Krishna Suthar
- Baylor Scott & White, Department of Internal Medicine,
Division of Hematology & Medical Oncology, Temple, TX
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McGinigle KL, Spangler EL, Ayyash K, Arya S, Settembrini AM, Thomas MM, Dell KE, Swiderski IJ, Davies MG, Setacci C, Urman RD, Howell SJ, Garg J, Ljungvist O, de Boer HD. A framework for perioperative care for lower extremity vascular bypasses: A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery. J Vasc Surg 2023; 77:1295-1315. [PMID: 36931611 DOI: 10.1016/j.jvs.2023.01.018] [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: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 03/17/2023]
Abstract
The Society for Vascular Surgery and the Enhanced Recovery After Surgery (ERAS) Society formally collaborated and elected an international, multi-disciplinary panel of experts to review the literature and provide evidence-based suggestions for coordinated perioperative care for patients undergoing infrainguinal bypass surgery for peripheral artery disease. Structured around the ERAS core elements, 26 suggestions were made and organized into preadmission, preoperative, intraoperative, and postoperative sections.
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Affiliation(s)
- Katharine L McGinigle
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Emily L Spangler
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Katie Ayyash
- Department of Perioperative Medicine (Merit), York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - Shipra Arya
- Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | | | - Merin M Thomas
- Lenox Hill Hospital, Northwell Health, New Hyde Park, NY
| | | | | | - Mark G Davies
- Department of Surgery, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Sciences Center, San Antonio, TX
| | - Carlo Setacci
- Department of Surgery Surgery, University of Siena, Siena, Italy
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Simon J Howell
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom
| | - Joy Garg
- Department of Vascular Surgery, Kaiser Permanente San Leandro, San Leandro, CA
| | - Olle Ljungvist
- Department of Surgery, Orebro University, Orebro, Sweden
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine, and Procedure Sedation and Analgesia, Martini General Hospital Groningen, Groningen, the Netherlands
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Khan AA, AbuAlrob H, Al-Alwani H, Ali DS, Almonaei K, Alsarraf F, Bogoch E, Dandurand K, Gazendam A, Juby AG, Mansoor W, Marr S, Morgante E, Myslik F, Schemitsch E, Schneider P, Thain J, Papaioannou A, Zalzal P. Post hip fracture orthogeriatric care-a Canadian position paper addressing challenges in care and strategies to meet quality indicators. Osteoporos Int 2023; 34:1011-1035. [PMID: 37014390 DOI: 10.1007/s00198-022-06640-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/12/2022] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis. OBJECTIVE A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care. METHODS A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today. CONCLUSION Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided.
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Affiliation(s)
- Aliya A Khan
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada.
| | - Hajar AbuAlrob
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Hatim Al-Alwani
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Dalal S Ali
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Khulod Almonaei
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Farah Alsarraf
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Earl Bogoch
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Karel Dandurand
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Aaron Gazendam
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Angela G Juby
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wasim Mansoor
- Trillium Health Partners, University of Toronto, Toronto, ON, Canada
| | - Sharon Marr
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Emmett Morgante
- Bone Research and Education Center Patient Support Program and Education Coordinator, Oakville, ON, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Western University, London, ON, Canada
| | - Emil Schemitsch
- Department of Surgery, Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Prism Schneider
- Department of Surgery, Division of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Jenny Thain
- Department of Medicine, Division of Geriatric Medicine, Western University, London, ON, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Paul Zalzal
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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48
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Rüggeberg A, Nickel E. Unrestricted drinking before surgery: a reply. Anaesthesia 2023; 78:532. [PMID: 36480421 DOI: 10.1111/anae.15936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Affiliation(s)
- A Rüggeberg
- Helios Klinikum Emil von Behring Berlin, Berlin, Germany
| | - E Nickel
- Helios Klinikum Emil von Behring Berlin, Berlin, Germany
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49
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de Klerk ES, de Grunt MN, Hollmann MW, Preckel B, Hermanides J, van Stijn MFM. Incidence of excessive preoperative fasting: a prospective observational study. Br J Anaesth 2023; 130:e440-e442. [PMID: 36670008 DOI: 10.1016/j.bja.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 01/20/2023] Open
Affiliation(s)
- Eline S de Klerk
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Midas N de Grunt
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Benedikt Preckel
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Jeroen Hermanides
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Mireille F M van Stijn
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.
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50
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Klein E, Mauri J, Lesserson LS, Nayyar P. Nil per os duration and anxiety: A single center cross-sectional study. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2023. [DOI: 10.1016/j.tacc.2023.101231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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