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Wang XH, Wang ZY, Shan ZR, Wang R, Wang ZP. Effects of Preoperative Oral Carbohydrates on Recovery After Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Trials. J Perianesth Nurs 2024:S1089-9472(24)00096-0. [PMID: 38980237 DOI: 10.1016/j.jopan.2024.03.007] [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: 12/15/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE The objective of this meta-analysis was to evaluate the efficacy of administering preoperative oral carbohydrates (CHO) compared to a control treatment in improving postoperative recovery outcomes for patients undergoing laparoscopic cholecystectomy (LC). DESIGN A meta-analysis of randomized controlled trials. METHODS Through systematic searches in PubMed, Embase, and the Cochrane Library, randomized controlled trials focusing on preoperative oral carbohydrates for patients undergoing LC were collected. Data analysis was conducted using the Revman 5.3 software. FINDINGS The meta-analysis incorporated 19 randomized studies, with a total of 1,568 participants. Meta-analysis results indicated that patients receiving CHO reported notably lower postoperative pain compared to those fasting (P = .006) or on placebo (P = .003). Furthermore, a significant reduction in preoperative hunger was observed in the CHO group compared to the controls (P = .002). A notable difference was also identified in the postoperative Homeostasis Model Assessment-IR changes between the CHO and control groups (P = .02). No significant variations were observed in thirst, postoperative nausea and vomiting, insulin level alterations, glucose level changes, duration of hospital stay, or recovery quality. CONCLUSIONS Preoperative oral carbohydrates may alleviate hunger and pain, and attenuate postoperative insulin resistance more effectively than either overnight fasting or placebo in patients undergoing LC.
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Affiliation(s)
- Xiao-Han Wang
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ze-Yang Wang
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zheng-Ru Shan
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Rui Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhi-Ping Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China; Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 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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Mert S, Çalışkan İ, Koruk S. The Effect of Menthol Ice on Laparoscopic Cholecystectomy Patients' Thirst, Dry Mouth, Mouth Taste, and Bad Mouth Odor: A Randomized Controlled Trial. J Perianesth Nurs 2024:S1089-9472(23)01114-0. [PMID: 38795086 DOI: 10.1016/j.jopan.2023.12.024] [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: 08/16/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 05/27/2024]
Abstract
PURPOSE This study aimed to determine the effect of menthol ice application on thirst, dry mouth, mouth taste, and bad mouth odor in patients who underwent laparoscopic cholecystectomy in the postoperative period. DESIGN The study was conducted as a randomized controlled trial with an experimental design. METHODS The study sample consisted of 90 patients who underwent laparoscopic cholecystectomy and met the inclusion criteria. Patients were divided into three groups by randomization program. Patients in the menthol ice and ice popsicle (ice prepared with drinking water only) group were administered menthol ice/ice popsicle (10 mL) twice at 20 minutes intervals. Patients in the control group did not receive any intervention. Routine practices of the clinic were performed by the nurses of the general surgery clinic. Postoperative thirst intensity, severity of dry mouth, bad taste, and bad odor in the mouth were evaluated at 0, 20, and 40 minutes. FINDINGS No statistically significant difference was found between the sociodemographic and clinical characteristics of the patients in the control group, menthol ice group, and ice popsicle group (P > .05). A statistically significant difference was found between the 3 groups in terms of thirst intensity and severity of dry mouth at times at the 20th and 40th minutes after the application (P < .01). We found a statistically significant difference between the bad taste and bad odor sensation scores of the patients in the control and intervention groups at the 20th and 40th minutes after the application (P < .05). CONCLUSIONS The study concluded that menthol ice and ice popsicle application are effective strategies to reduce the intensity of thirst, severity of dry mouth, bad taste, and bad odor in postoperative patients.
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Affiliation(s)
- Sabiha Mert
- İstanbul Galata University, Vocational School, Anesthesia program, İstanbul, Turkey
| | - İlknur Çalışkan
- Izmir Tinaztepe Unıversity, Faculty of Health Sciences, Department of Nursing, Izmir, Turkey.
| | - Senem Koruk
- Istanbul Medeniyet University, Faculty of Medicine, Department of Anesthesiology and Reanimation, İstanbul, Turkey
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Kassymova G, Sydsjö G, Borendal Wodlin N, Nilsson L, Kjølhede P. The Impact of Symptoms of Depression, Anxiety, and Low Stress-Coping Capacity on the Effects of Telephone Follow-Up on Recovery Measures After Hysterectomy. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:304-318. [PMID: 38558946 PMCID: PMC10979684 DOI: 10.1089/whr.2023.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 04/04/2024]
Abstract
Background To investigate if symptoms of depression, anxiety, and stress-coping capacity have an impact on the effect of telephone follow-up (TFU) on trajectories of six recovery measures after hysterectomy and influence the occurrence of unplanned telephone contacts (uTCs) and unplanned visits (uVs) to health care providers. Material and Methods A post hoc nonrandomized analysis of participants enrolled in a randomized, four-armed, single-blinded, controlled multicenter intervention study comprising 487 women where the women were allocated 1:1:1:1 to one of four TFU models. The Swedish Postoperative Symptom Questionnaire (SPSQ) and two health-related quality of life questionnaires, the EuroQoL-5 dimension with three levels (EQ-5 D-3 L) and the Short-Form-Health Survey (SF-36) assessed the recovery measures. The six recovery measures consisted of the EQ-5D-3L health index, the SF-36 physical component summary (PCS) and mental component summary (MCS), and the maximum and average pain intensity, and symptom sum score obtained from the SPSQ. Psychological distress was evaluated by the psychometric forms, the Hospital Anxiety and Depression Scale and the Stress Coping Inventory. The occurrence of uTC and uV within the 6 weeks of follow-up was registered. Results Preoperative anxiety, depression, and stress-coping capacity did not modify the effects of the TFU models on the trajectories of the recovery measures, although anxiety and depression were strongly associated with all six recovery measures. uTCs, but not uVs occurred more often in the women with anxiety. Conclusions Preoperative anxiety, depression, and stress-coping capacity did not appear to influence the effects of TFU contacts on the recovery measures after hysterectomy. Preoperative anxiety seemed to increase the occurrence of uTC. Clinical Trials Registration: ClinicalTrials.gov (NCT01526668).
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Affiliation(s)
- Gulnara Kassymova
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, and Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, and Linköping University, Linköping, Sweden
| | - Ninnie Borendal Wodlin
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, and Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Department of Biomedical and Clinical Sciences, and Linköping University, Linköping, Sweden
- Department of Anesthesiology and Intensive Care, Linköping University, Linköping, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, and Linköping University, Linköping, Sweden
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Wang X, Zhuang J, Cheng J, Wang Z, Sheng J, Guo S, Wang R, Wang Z. Effect of preoperative oral carbohydrates on insulin resistance in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial. Langenbecks Arch Surg 2024; 409:77. [PMID: 38411704 PMCID: PMC10899310 DOI: 10.1007/s00423-024-03268-1] [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: 11/06/2023] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE The present research seeks to clarify the consequences of two specific preoperative oral carbohydrate (POC) amounts on insulin resistance (IR) and stomach evacuation in laparoscopic cholecystectomy (LC) patients. METHODS A total of 129 patients set for elective LC procedures were randomly assigned to a control group (C, n = 45), a 200 mL POC group (P1, n = 42), and a 400 mL POC group (P2, n = 42). The C group was fasted from midnight until surgery, whereas the P1 and P2 groups received their respective carbohydrate volumes 2-4 h before anesthesia. Fasting blood glucose, insulin, and glucagon concentrations were measured at three junctures. IR metrics were derived by employing the homeostasis model assessment. Gastric volume was measured before anesthesia using gastric ultrasound. Inter-group comparisons included IR indicators, subjective comfort scores, and hemodynamic data. RESULTS At T2, the C group exhibited reduced glucose concentrations compared to the P2 group (4.73 ± 0.64 vs. 5.26 ± 1.02 mmol/L, p < 0.05). The Perlas grading indicated that grade 1 was more prevalent in the P2 group than in the P1 and C groups (18 [42.9%] vs. 6 [14.3%] and 1 [2.2%], p < 0.05). Additionally, thirst and hunger metrics for the P2 group were notably reduced compared to the C group at both T2 and T3. CONCLUSION Administering either 200 mL or 400 mL of carbohydrates 2-4 h pre-surgery had no detectable impact on IR or gastric volume in LC patients. TRIAL REGISTRATION ChiCTR, ChiCTR2200065648. Registered January 13, 2023, http://www.chictr.org.cn .
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Affiliation(s)
- Xiaohan Wang
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Jingwen Zhuang
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Jianxin Cheng
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Zeyang Wang
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Jingyi Sheng
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Shanshan Guo
- Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Rui Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China
| | - Zhiping Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004, Jiangsu, China.
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China.
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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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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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Ertural F, Küçükakça Çelik G, Özçelik H. Effect of Oral Carbohydrate Solution Administered Before Hip Arthroplasty on Preoperative Anxiety and Postoperative Patient Comfort: A Randomized Controlled Trial. J Perianesth Nurs 2023; 38:461-468. [PMID: 36803737 DOI: 10.1016/j.jopan.2022.08.012] [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: 05/20/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 02/18/2023]
Abstract
PURPOSE This study aimed to determine the effect of oral carbohydrate solution (OCS) administered before hip arthroplasty (HA) on preoperative anxiety and postoperative patient comfort. DESIGN The study was a randomized controlled clinical trial. METHODS Fifty patients undergoing HA were randomized into two groups: The intervention group (n = 25) received OCS before surgery, and the control group (n = 25) fasted from midnight till surgery. The patients' preoperative anxiety was assessed using the State-Trait Anxiety Inventory (STAI), symptoms affecting postoperative patient comfort parameters using the Visual Analog Scale (VAS), and comfort levels specific to HA surgery using the Post-Hip Replacement Comfort Scale (PHRCS). Pre- and post-operative blood glucose levels of the patients were measured. FINDINGS In intragroup and intergroup assessments, the decrease in the preoperative and postoperative anxiety, pain, thirst, hunger, and nausea/vomiting levels were statistically significant (P < .05) in the OCS group. The OCS group's comfort levels specific to hip replacement were higher than those of the control group (P ≤ .001). In the intergroup and intragroup assessment of the patients' blood glucose levels, there was a statistically significant difference in favor of the OCS group (P < .05). CONCLUSIONS The results of this study provide evidence supporting OCS administration before HA surgery.
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Affiliation(s)
- Fadime Ertural
- Department of Operating Room Services, Kapodokya University, Nevşehir, Turkey
| | - Gülden Küçükakça Çelik
- Nursing Department, Nevşehir Hacı Bektaş Veli University Semra ve Vefa Küçük Faculty of Health Sciences, Nevşehir-Turkey.
| | - Hanife Özçelik
- Nursing Department, Niğde Halis Demir University Zübeyde Hanım Faculty of Health Sciences, Niğde-Turkey
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Seyhan Ak E, Türkmen A, Sinmaz T, Biçer ÖS. Evaluation of Thirst in the Early Postoperative Period in Patients Undergoing Orthopedic Surgery. J Perianesth Nurs 2022; 38:448-453. [PMID: 36586782 DOI: 10.1016/j.jopan.2022.08.007] [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: 03/24/2022] [Revised: 07/27/2022] [Accepted: 08/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Thirst, is a subjective symptom that has a high incidence in the early postoperative period and causes patients to experience intense discomfort. PURPOSE The aim of this study is to determine thirst and the factors affecting thirst in the early postoperative period in patients undergoing orthopedic surgery. DESIGN The research was carried out as a descriptive-cross sectional study with 177 patients between September 2021 and January 2022. METHODS Data were collected using the "Descriptive and clinical features form," "Thirst and Symptoms Associated with Thirst Evaluation Form." For descriptive analysis, frequency, percentage distribution, mean, and minimum-maximum values were analyzed. The Chi-square test was used to compare the data according to the groups. Before starting the research, necessary ethics committee and institutional permission were obtained. FINDINGS The mean perioperative thirst time of the patients was 15.25 ± 3.61 hours and the mean anesthesia time was 2.32 ± 1.13 hours. When the perioperative thirst duration was compared with the type of surgery, duration of operation, type of anesthesia, duration of anesthesia, duration of fasting, intubation and duration of stay in PACU, there was a statistical significance between them (P > .05). CONCLUSION The most common symptoms in patients undergoing orthopedic surgery were thirst and dry mouth. Surgery type, operation duration, anesthesia type, anesthesia duration, fasting duration, intubation status and duration of stay in PACU were the factors affecting the perioperative thirst status of the patients.
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Affiliation(s)
- Ezgi Seyhan Ak
- Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Surgical Nursing Department, Istanbul, Turkey
| | - Açelya Türkmen
- Çukurova University, Faculty of Health Sciences, Surgical Nursing Department, Adana, Turkey.
| | - Tuba Sinmaz
- Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Surgical Nursing Department, Istanbul, Turkey
| | - Ömer Sunkar Biçer
- Çukurova University, Faculty of Medicine, Department of Orthopedics and Traumatology, Adana, Turkey
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Yayla A, Eskici İlgin V, Kılınç T, Karaman Özlü Z, Ejder Apay S. Nausea and Vomiting After Laparoscopic Cholecystectomy: Analysis of Predictive Factors. J Perianesth Nurs 2022; 37:834-841. [PMID: 35382962 DOI: 10.1016/j.jopan.2022.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/02/2022] [Accepted: 01/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to identify the factors predictive of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. DESIGN This is a descriptive, cross-sectional study. METHODS In total, 172 patients completed the study. "The Questionnaire Form," "Visual Analog Scale," "Nausea Scale," and "Anxiety Specific to Surgery Questionnaire" created by the researchers were used for data collection. FINDINGS At the second postoperative hour, 55.8% of the patients had nausea, 20.3% had vomiting and 75% had severe pain. The severity of nausea, vomiting, and pain decreased with time. Age, gender, smoking, motion sickness, postoperative pain, opioid use, preoperative fasting time, time of first postoperative fluid intake and preoperative anxiety score were found to be among the factors predictive of PONV (P < .05). CONCLUSIONS High rates of postoperative nausea and vomiting were recorded. The factors predictive of PONV can be evaluated in the preoperative period, and PONV can be controlled with early interventions and treatment of patients in the risk group.
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Affiliation(s)
- Ayşegül Yayla
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey.
| | - Vesile Eskici İlgin
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey
| | - Tülay Kılınç
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey
| | - Zeynep Karaman Özlü
- Department of Surgical Nursing, Faculty of Nursing, Anesthesiology Clinical Research Office, Atatürk University, Erzurum, Turkey
| | - Serap Ejder Apay
- Atatürk University Health Science Faculty, Department of Midwifery, Erzurum, Turkey
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11
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Rüggeberg A, Nickel EA. Unrestricted drinking before surgery: an iterative quality improvement study. Anaesthesia 2022; 77:1386-1394. [PMID: 36130830 DOI: 10.1111/anae.15855] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 01/11/2023]
Abstract
Average pre-operative fasting times for clear liquids are many times longer than those specified in national and international guidelines. We sought to decrease fasting times by applying a quality management tool aimed at continuous improvement. Through the application of iterative 'plan-do-study-act' cycles, tools to reduce pre-operative liquid fasting times were developed and applied, the effects measured, analysed and interpreted and the conclusions used to inform the next plan-do-study-act cycle. The first step was the introduction of unrestricted drinking until the patient was called to the operating theatre, with training of anaesthetic staff, adaption of local standard procedures and verbal information for patients. This did not result in short liquid fasting times, median (IQR [range]) 12.0 (9.5-14.0 [0.8-23.5]) h. In the second cycle, fasting cards were introduced as a subliminal written training tool for staff, patients and their relatives. This enabled short liquid fasting times to be achieved for outpatients (2.6 (0.8-5.1 [0.3-16]) h) and pre-admission patients (3.4 (1.8-9.4 [0.2-17.2]) h), but not for inpatients (6.5 (2.0-11.7 [0.2-16.2]) h). The third cycle included lectures for ward staff, putting up information posters throughout the hospital, revision of all written materials and provision of screencasts on the homepage for staff and patients. This decreased median liquid fasting time to 2.1 (1.2-3.8 [0.4-18.8]; p < 0.0001) h, with inpatients having the shortest fasting time of 1.4 (1.1-3.8 [0.4-18.8]) h. Repeated quality improvement cycles, adapted to local context, can support sustained reductions in pre-operative liquid fasting times.
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Affiliation(s)
- A Rüggeberg
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
| | - E A Nickel
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
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Somnuke P, Kitisin N, Chumklud P, Kunavuttitagool P, Deepinta P, Wadrod A, Prachayakul W, Amornyotin S, Raykateeraroj N. Hard-Candy Consumption Does Not Have an Effect on Volume and pH of Gastric Content in Patients Undergoing Elective Gastrointestinal Endoscopic Procedures: A Randomized Controlled Trial. Ther Clin Risk Manag 2022; 18:1049-1057. [PMID: 36467617 PMCID: PMC9716931 DOI: 10.2147/tcrm.s377421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/22/2022] [Indexed: 08/03/2023] Open
Abstract
Purpose This study aimed to determine the effect of hard candies on gastric content volume and pH in patients undergoing elective esophagogastroduodenoscopy and colonoscopy. Additionally, the study evaluated the difficulty of the procedure, complications, and satisfaction levels of the endoscopist and patient. Patients and Methods A randomized controlled study equally recruited 108 outpatients to candy and control groups. The patients in the candy group could consume sugar-free candies within 2 hours before anesthesia, while the controls remained fasted. The endoscopic procedure began under topical pharyngeal anesthesia and intravenous sedation. A blinded endoscopist suctioned the gastric volume through an endoscope. A blinded anesthesia provider tested the gastric pH with a pH meter. The primary outcome variables were gastric volume and pH. The secondary outcome variables were complications, the difficulty of the procedure, and endoscopist and patient satisfaction. Results The characteristics of both patient groups were comparable. The mean gastric volume of the candy group (0.43 [0.27-0.67] mL/kg) was not significantly different from that of the control group (0.32 [0.19-0.55] mL/kg). The gastric pH of both groups was similar: 1.40 (1.10-1.70) for the candy group and 1.40 (1.20-1.90) for the control group. The procedure-difficulty score of the candy group was higher than that of the control group. The satisfaction scores rated by the endoscopist and the patients in both groups were comparable. In addition, most endoscopists and patients in the candy and control groups reported being "very satisfied". No complications were observed in either group. Conclusion Hard candies did not affect gastric volume or pH. Elective gastrointestinal endoscopic procedures in adult patients who preoperatively consume candies could proceed to prevent delays and disruption of workflows.
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Affiliation(s)
- Pawit Somnuke
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Nuanprae Kitisin
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Phornprasurt Chumklud
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Pishsinee Kunavuttitagool
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Penpuk Deepinta
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Araya Wadrod
- Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Warayu Prachayakul
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Somchai Amornyotin
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Nattaya Raykateeraroj
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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Toker E, Gökduman Keleş M, Omaç Sönmez M. The anxiety levels of midwives and nurses working for filiation during COVID-19: A sample of Turkey. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2022; 78:142-151. [PMID: 36052853 DOI: 10.1080/19338244.2022.2118211] [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: 06/15/2023]
Abstract
This study examines the anxiety levels of midwives and nurses working for filiation during management of the COVID-19 pandemic(n = 205) The cross-sectional data were collected using State-Trait Anxiety Inventory (STAI-I and II). Having COVID-19 test done and provision of protective equipment affected their STAI-I and II. High anxiety status was found to be those who did not experience fear of carrying the coronavirus to their families (O.R: 1.128), who had diagnosis tests done (O.R:0.888), who had good feeling states before COVID-19 process (O.R:1.076). Information about infection spreads, required equipment and providing social support will lead to a reduction in their anxiety levels in working filiation.
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Affiliation(s)
- Eylem Toker
- Department of Midwifery, Faculty of Health Sciences, Tarsus University, Mersin, Turkey
| | - Mine Gökduman Keleş
- Development of Health Department, Kahramanmaraş Provincial Health Directorate, Kahramanmaraş, Turkey
| | - Mehtap Omaç Sönmez
- Department of Public Health Nursing, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey
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14
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van Noort HHJ, Lamers CR, Vermeulen H, Huisman-de Waal G, Witteman BJM. Patient Education Regarding Fasting Recommendations to Shorten Fasting Times in Patients Undergoing Esophagogastroduodenoscopy: A Controlled Pilot Study. Gastroenterol Nurs 2022; 45:342-353. [PMID: 35856722 PMCID: PMC9514738 DOI: 10.1097/sga.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
This study evaluated the applicability and efficacy of patient education regarding fasting recommendations to shorten fasting times in patients undergoing esophagogastroduodenoscopy (EGD). A prospective nonrandomized controlled pilot study was performed. The intervention group (IG) was educated by nurses to eat until 6 hours and drink until 2 hours before EGD. The control group (CG) received usual care. Outcomes were applicability as perceived by patients, adherence to fasting recommendations, gastric visibility, and patients' comfort. A total of 109 patients were included of whom 42 were IG patients (37%). Patients' perspectives on fasting, their experienced discomfort, professional support, and circadian rhythm influenced application of fasting recommendations. Adherence to length of fasting from foods improved with 3:14 hours ( p < .001) and from liquids with 5:22 hours ( p < .001) in the IG compared with the CG. Gastric visibility during EGD was better in the IG than in the CG. The IG patients experienced significant less thirst, hunger, headache, and anxiety. To successfully reduce fasting times, fasting education should include positive, individual instructions, which help patients apply the fasting recommendations within their biorhythm. Positive, concrete instructions by nurses shortened fasting times before EGD, which improved gastric visibility and reduced patient discomfort.
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Affiliation(s)
- Harm H. J. van Noort
- Correspondence to: Harm H. J. van Noort, MSc, RN, Department of Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands ()
| | - Carlijn R. Lamers
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Hester Vermeulen
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Getty Huisman-de Waal
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Ben J. M. Witteman
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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15
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Ahmadipour M, Sattari H, Nejad MA. Incidence and risk factors related to anxiety of children and adolescents before elective surgery. Eur J Transl Myol 2022; 32. [PMID: 35546729 PMCID: PMC9295168 DOI: 10.4081/ejtm.2022.10449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/11/2022] [Indexed: 11/22/2022] Open
Abstract
The goal of this study was to evaluate the preoperative anxiety in children and adolescents and to identify some of the risk factors associated with the incidence of anxiety in 9–18 years old group. Children and adolescents 9–18 years old hospitalized the night before elective surgeries were analyzed in terms of incidence and severity of anxiety using the State-Trait Anxiety Inventory (STAI) measure. Of the 164 patients, 111 (67.6%) suffered from preoperative anxiety. The incidence of anxiety in children aged 9–12 was 2.88 times the anxiety of those aged 12–18 (OR = 2.88) (1.65, 5.98). Moreover, the incidence of anxiety in only children was 0.65 times that of children with siblings (OR = 0.78) (0.11,2.93), and in patients with a history of hospitalization, the incidence was 1.85 times the stress in children without hospitalization history (OR = 1.85)(1.31,3.99); finally, the incidence of anxiety in children of higher socioeconomic status was lower compared with those of lower socioeconomic status (OR = 0.13) (0.08,0.35). Having close frend or family in the healthcare staff decreased the prevalence (OR = 0.64 (0.23,1.79) and severity of anxiety (47.02 ± 5.48 vs. 54.18 ± 7.18) (P-value = 0.001). There was no relationship between gender and the incidence of anxiety (OR = 1). Incidence of preoperative anexiety in foriner was1.72 times of persion patients (OR=1.72) (0.99,4.25). The severity of anxiety was lower in boys (46.22 ± 6.68) compared with girls (52.55 ± 7.52) (P-value = 0.002) and lower in patients of medium-to-high socioeconomic status (43.64 ± 5.45) compared with those with lower socioeconomic status (49.66 ± 6.49) (P-value = 0.003). There was no relationship between being an only child and severity of anxiety (P-value = 0.54) (48.31 ± 5.05 vs. 48.12 ± 6.81). However, anxiety was more severe in patients with a history of hospitalization (50.55 ± 4.64) (49.2 ± 6.23) (P-value = 0.09). Severity of anexiety was not dependent to nationality of patients(P-value = 0.6) .Taken together, our data suggest that various methods should be used to reduce anxiety and associated complications, regarding the high prevalence of anxiety in mentioned groups of children and adolescents.
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Affiliation(s)
- Maryam Ahmadipour
- Faculty of Medicine, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman.
| | - Hossein Sattari
- Medical school of Kerman University of. Medical sciences, Kerman.
| | - Mehdi Ahmadi Nejad
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman.
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16
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Torabikhah M, Yousefi H, Ansari AHM, Musarezaie A. The Effect of Reducing the Fasting Time on Postoperative Pain in Orthopaedic Patients: A Randomized Controlled Trial. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:310-315. [PMID: 34422610 PMCID: PMC8344633 DOI: 10.4103/ijnmr.ijnmr_291_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/06/2020] [Accepted: 02/08/2021] [Indexed: 11/04/2022]
Abstract
Background Patients undergoing orthopedics surgery experience the most severe postoperative pain. The fasting time is a factor that affects this complication. The aim of this study was to investigate the impact of fasting time reduction by using oral carbohydrate on postoperative pain and analgesic consumption in orthopedic patients. Materials and Methods This randomized control trial was conducted between November 2017 and December 2018. Sixty-four patients were randomly assigned into the intervention (which consumed 200 mL of the 12.50% carbohydrate, 2 h before the surgery) and the control group (which was fasted from midnight). Postoperative pain was measured by visual analog scale; the amount of the consumed analgesics was also recorded. The data were analyzed by using Chi-square and t-test. Results The mean (SD) of the pain scores in the control group immediately and 2, 4, 6, 12 and 24 h after consciousness were 7.19 (2.64), 6.69 (2.17), 6.31 (2.05), 6.16 (2.08), 6.06 (2.24), and 5.38 (1.86), respectively. These scores for the intervention group were 7.44 (1.48), 6.31 (1.25), 5.72 (1.17), 5.59 (1.43), 5.25 (1.13), and 4.97 (1.57). The mean of the pain scores between two groups was not different (p > 0.05). The amount of the consumed morphine (t 61= -2.10, p = 0.039), pethidine (t 62= -2.25, p = 0.028), and diclofenac (t 62= -2.51, p = 0.015) were significantly different between the two groups. Conclusions The pain intensity in the patients with shortened fasting time was lower, but it was not statistically significant. Moreover, reducing fasting time by using carbohydrate significantly reduced the use of analgesics.
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Affiliation(s)
- Mohsen Torabikhah
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hojatollah Yousefi
- Nursing and Midwifery Care Research Center, Adult Nursing Department, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Amir Musarezaie
- Nursing and Midwifery Care Research Center, Adult Nursing Department, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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van Noort HHJ, Eskes AM, Vermeulen H, Besselink MG, Moeling M, Ubbink DT, Huisman-de Waal G, Witteman BJM. Fasting habits over a 10-year period: An observational study on adherence to preoperative fasting and postoperative restoration of oral intake in 2 Dutch hospitals. Surgery 2021; 170:532-540. [PMID: 33712307 DOI: 10.1016/j.surg.2021.01.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/29/2020] [Accepted: 01/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Since 1999, international guidelines recommend fasting from solid foods up to 6 hours and clear liquids up to 2 hours before surgery. Early recovery after surgery programs recommend restoration of oral intake as soon as possible. This study determines adherence to these guidelines up to 20 years after its introduction. METHODS A 2-center observational study with a 10-year interval was performed in the Netherlands. In period 1 (2009), preoperative fasting time was observed as primary outcome. In period 2 (2019), preoperative fasting and postoperative restoration of oral intake were observed. Fasting times were collected using an interview-assisted questionnaire. RESULTS During both periods, 311 patients were included from vascular, trauma, orthopedic, urological, oncological, gastrointestinal, and ear-nose-throat and maxillary surgical units. Duration of preoperative fasting was prolonged in 290 (90.3%) patients for solid foods and in 208 (67.8%) patients for clear liquids. Median duration of preoperative fasting from solid foods and clear liquids was respectively 2.5 and 3 times the recommended 6 and 2 hours, with no improvements from one period to another. Postoperative food intake was resumed within 4 hours in 30.7% of the patients. Median duration of perioperative fasting was 23:46 hours (interquartile range 20:00-30:30 hours) for solid foods and 11:00 hours (interquartile range 7:53-16:00 hours) for clear liquids. CONCLUSION Old habits die hard. Despite 20 years of fasting guidelines, surgical patients are still exposed erroneously to prolonged fasting in 2 hospitals. Patients should be encouraged to eat and drink until 6 and 2 hours, respectively, before surgery and to restart eating after surgery.
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Affiliation(s)
- Harm H J van Noort
- Department of Nutrition, Physical Activity and Sports, Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Anne M Eskes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands; Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia. https://twitter.com/Anne_Eskes
| | - Hester Vermeulen
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands. https://twitter.com/hvermeulen67
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, The Netherlands. https://twitter.com/MarcBesselink
| | - Miranda Moeling
- Department of Nutrition and Dietetics, Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Dirk T Ubbink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Getty Huisman-de Waal
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands. https://twitter.com/getty_huisman
| | - Ben J M Witteman
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; Division of Nutrition and Disease, Wageningen University, The Netherlands
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18
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Nascimento LAD, Garcia AKA, Conchon MF, Lopes MVDO, Fonseca LF. Concept analysis of Perioperative Thirst for the development of a new nursing diagnosis. Rev Bras Enferm 2021; 74:e20200065. [PMID: 33681954 DOI: 10.1590/0034-7167-2020-0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/13/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the perioperative thirst concept for the development of a new diagnostic structure according to NANDA International. METHODS a concept analysis study based on the framework proposed by Walker and Avant, instrumentalized through an integrative literature review based on SCOPUS, CINAHL, PUBMED, LILACS, and WOS. The elaboration of the diagnostic structure followed NANDA International guidelines. RESULTS 41 studies were analyzed revealing that perioperative thirst is prevalent and intense, having visceral and behavioral attributes as the core of the concept. Antecedents indicate that surgical patients are vulnerable to thirst; and consequents 16 signs and symptoms were organized and model cases were developed. A diagnostic structure has been developed for perioperative thirst. FINAL CONSIDERATIONS concept analysis allowed language standardization that describes thirsty patients, helping the identification, planning of actions and communication of perioperative nursing care.
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19
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Effects of a short message service (SMS) by cellular phone to improve compliance with fasting guidelines in patients undergoing elective surgery: a retrospective observational study. BMC Health Serv Res 2021; 21:27. [PMID: 33407397 PMCID: PMC7788820 DOI: 10.1186/s12913-020-06039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Contemporary perioperative fasting guidelines aim to alleviate patient discomfort before surgery and enhance postoperative recovery whilst seeking to reduce the risk of pulmonary aspiration during anesthesia. The impact of a short message service (SMS) reminder on fasting guideline compliance is unknown. Therefore, we performed a retrospective observational study and quality improvement project aiming to quantify the extent of excessive and prolonged fasting, and then assessed the impact of a SMS reminder in reducing fasting times. Methods After ethics committee approval we performed a retrospective observational study investigating preoperative fasting times of adult patients undergoing elective surgery. First, we assessed whether the fasting guideline times were adhered to (Standard Care group). All patients received internationally recommended fasting guidelines in the form of a written hospital policy document. We then implemented an additional prompt via a mobile phone SMS 1 day prior to surgery containing a reminder of fasting guideline times (SMS group). The primary aims were to compare fasting times between the Standard Care group and the SMS group. Results The fasting times of 160 patients in the Standard Care group and 110 patients in the SMS group were evaluated. Adherence to the fasting guidelines for solids occurred in 14 patients (8.8%) in the Standard Care group vs. Twenty-two patients (13.6%) in the SMS group (p=0.01). Adherence to the fasting guidelines for fluids occurred in 4 patients (2.5%) in the Standard Care group vs. Ten patients (6.3%) in the SMS group (p=0.023). Patients in the Standard Care group had a longer median (inter-quartile range (IQR)) fasting time for fluids compared the SMS group [6.5 h (IQR 4.5:11) vs 3.5 h (IQR 3:8.5), p< 0.0001]. Median fasting times for solids were 11 h (IQR 7:14) in the Standard Care group and 11.5 h (IQR 7:13.5) in the SMS group (p=0.756). Conclusion Adherence to internationally recommended fasting guidelines for patients undergoing elective surgery is poor. The introduction of a fasting guideline reminder via a mobile phone SMS in addition to a written hospital policy improved adherence to fasting advice and reduced the fasting times for fluids but not for solids. The use of an SMS reminder of fasting guidelines is a simple, feasible, low-cost, and effective tool in minimising excessive fasting for fluids among elective surgical patients. Trial registration ACTRN12619001232123 (Australia New Zealand Clinical Trials Registry). Registered 6th September 2019 (retrospectively registered).
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20
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TEREZA DENISEM, BALDASSO GABRIELAM, PAES RODRIGOS, PACHECO MARIAE, ROSA PATRÍCIAP, VENDRAMINE BEATRIZ, HULSE SERGIOC, CAPASSO RAFFAELE, DUTRA RAFAELC. Evaluation of the protocol for thirst management using ice popsicles in the immediate postoperative period: A pilot study in southern Brazilian hospital. AN ACAD BRAS CIENC 2021. [DOI: 10.1590/0001-3765202120201260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- DENISE M. TEREZA
- Universidade Federal de Santa Catarina, Brazil; Universidade Federal de Santa Catarina, Brazil
| | | | | | | | | | | | | | | | - RAFAEL C. DUTRA
- Universidade Federal de Santa Catarina, Brazil; Universidade Federal de Santa Catarina, Brazil
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21
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Morgan KL, Levin AI, Esterhuizen TM. The incidence of maternal hypoglycaemia with prolonged fasting before elective caesarean section. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.4.2585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- KL Morgan
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town,
South Africa
| | - AI Levin
- Department of Anaesthesiology and Critical Care, Stellenbosch University,
South Africa
| | - TM Esterhuizen
- Division of Epidemiology and Biostatistics, Stellenbosch University,
South Africa
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22
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Yilmaz M, Çelik M. The Effects of Preoperative Fasting on Patients Undergoing Thoracic Surgery. J Perianesth Nurs 2020; 36:167-173. [PMID: 33303342 DOI: 10.1016/j.jopan.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to determine the effects of fasting before surgery on patients undergoing thoracic surgery. DESIGN This descriptive cross-sectional study was conducted from January 1 to June 30, 2017. METHODS The study was carried out with 85 patients who underwent thoracotomy, mediastinoscopy, or rib resection in the thoracic surgery department of a university hospital. All patients started fasting midnight before day of surgery. Data were collected using a questionnaire, Visual Analog Patient Satisfaction Scale, and preoperative laboratory findings form. FINDINGS The mean fasting hours of solids and clear fluids were 8 and 16, respectively, and the mean duration of preoperative fasting (POF) was 10.16 (SD = 1.67), total fasting time average was 28.09 (SD = 7.11). Total protein and albumin levels decreased, and glucose level increased after surgery. The difference between total protein, albumin, and glucose levels preoperatively and postoperatively was significant (P < .05). The difference between patient satisfaction and thirst was found to be statistically significant (P < .05). A positive correlation was found between POF and thirst (r = 0.450; P = .000), hunger (r = 0.402; P = .000), total protein (r = 0.508; P = .000), albumin (r = 0.537; P = .000), and glucose levels (r = 0.371; P = .000). CONCLUSIONS POF had an adverse effect on thirst, hunger, and total protein as well as albumin and glucose levels.
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Affiliation(s)
- Meryem Yilmaz
- Nursing Division, Department of Surgical Nursing, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Meltem Çelik
- Thoracic Surgery Department, Sivas Cumhuriyet University, Sivas, Turkey
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Oral carbohydrate solution cause an inflammatory response when aspirated into the lungs in mice. J Anesth 2020; 35:86-92. [PMID: 33221959 DOI: 10.1007/s00540-020-02873-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Many studies have been published on the beneficial effects of oral carbohydrate solutions (OCS) administered prior to surgery. However, the risk of pulmonary aspiration cannot be excluded in all patients undergoing anesthesia. But, there are few studies on the safety of OCS at lung aspiration. METHODS Experiments were conducted with mice (Nine- to ten-week-old male BALB/c mice weighted 23-26 g). Lung aspiration was performed by intratracheal administration of OCS and its major constituents, fructose and maltodextrin. Bronchoalveolar lavage fluid (BALF) was collected 3 and 24 h after lung aspiration. The level of Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and macrophage inflammatory protein-2 (MIP-2) were measured in BALF. The total white blood cell, neutrophil counts, wet to dry ratio and histological examination were performed in BALF and lung tissue, respectively, at 24 h after aspiration. RESULTS The OCS increased the level of TNF-α, IL-6 and MIP-2 at 3 h and the neutrophil count at 24 h in BALFs, compared to a phosphate-buffered saline (PBS) group. The increase in IL-6 level induced by OCS was maintained for 24 h. The OCS also increased the number of white blood cells and the percentage of neutrophils in BALFs. Compared to fructose, maltodextrin significantly increased the production of MIP-2 in BALFs. OCS and maltodextrin also increased neutrophil recruitment in lung tissue. CONCLUSION Aspiration of OCS may cause inflammation of the lungs. The preoperative use of OCS may require caution under specific clinical conditions, such as patients at risk of lung aspiration.
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Abstract
PURPOSE OF REVIEW Preoperative fasting guidelines are generalized to elective procedures and usually do not distinguish between the ambulatory and inpatient setting. Prevalence of aspiration is low while prolonged preoperative fasting is common clinical reality. Recently, changes in preoperative fasting guidelines have been widely discussed. RECENT FINDINGS Rates of prolonged clear fluid fasting (>4 h) prior to surgery are reported in up to 80% of patients with mean fasting duration of up to 16 h and beyond. Prolonged fasting may result in adverse effects such as intraoperative hemodynamic instability, postoperative delirium, patient discomfort, and extended hospital length of stay. Liberal approaches allowing clear fluids up to 1 h prior to anesthesia or until premedication/call to the operating room have shown no increase in adverse events among children. Various anesthesia societies now encourage clear fluid intake up to 1 h prior to pediatric elective anesthesia. Similar reports in the adult cohort are scarce. SUMMARY Allowing sips of water until call to the operating room may help reducing prolonged preoperative fasting and improving patient comfort while keeping a flexibility in operating room schedule. The feasibility and safety of a liberal clear fluid fasting regimen among adults undergoing elective anesthesia needs to be evaluated in future studies.
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Virgens IPAD, de Carvalho ALM, Nagashima YG, Silva FM, Fayh APT. Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study. SAO PAULO MED J 2020; 138:407-413. [PMID: 33053049 PMCID: PMC9673861 DOI: 10.1590/1516-3180.2020.0084.r1.30062020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/30/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND During a surgical procedure, patients are often subjected to fasting for times that are more prolonged than the ideal, which may lead to complications. OBJECTIVE To evaluate the duration of perioperative fasting and its association with postoperative complications, length of hospital stay (LOS) and mortality among gastric and colorectal cancer patients. DESIGN AND SETTING Cohort study developed in a surgical oncology hospital in the city of Natal (Rio Grande do Norte, Brazil). METHODS Patients aged over 18 years were included. The Clavien-Dindo surgical complication scale was used to evaluate occurrences of postoperative complications. LOS was defined as the number of days for which patients stayed in the hospital after surgery, or until the day of death. RESULTS Seventy-seven patients participated (59.8 ± 11.8 years; 54.5% females; 70.1% with bowel tumor). The incidences of postoperative complications and death were 59.7% and 3.9%, respectively. The duration of perioperative fasting was 59.0 ± 21.4 hours, and it was higher among non-survivors and among patients with prolonged hospital stay (≥ 6 days). For each one-hour increase in the durations of perioperative and postoperative fasting, the odds of prolonged hospitalization increased by 12% (odds ratio, OR = 1.12; 95% confidence interval, CI 1.04-1.20) and 5% (OR = 1.05; 95% CI 1.02-1.08), respectively. CONCLUSION Prolonged perioperative fasting, especially in the postoperative period, was observed in a sample of patients with gastric and colorectal cancer, and this was an independent predictor of LOS.
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Affiliation(s)
- Isabel Pinto Amorim das Virgens
- BSc. Dietitian and Master's student, Postgraduate Program on Health Sciences, Universidade Federal do Rio Grande do Norte (UFRN), Natal (RN), Brazil.
| | - Ana Lúcia Miranda de Carvalho
- MSc. Dietitian, Surgical Oncology Department, Luiz Antônio Hospital, Liga Norteriograndense Contra o Câncer, Natal (RN), Brazil.
| | - Yasmim Guerreiro Nagashima
- BSc. Dietitian, Surgical Oncology Department, Luiz Antônio Hospital, Liga Norteriograndense Contra o Câncer, Natal (RN), Brazil.
| | - Flavia Moraes Silva
- PhD. Dietitian and Adjunct Professor, Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil.
| | - Ana Paula Trussardi Fayh
- PhD. Dietitian and Associated Professor, Department of Nutrition, Universidade Federal do Rio Grande do Norte (UFRN), Natal (RN), Brazil.
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Denkyi L. An exploration of pre-operative fasting practices in adult patients having elective surgery. ACTA ACUST UNITED AC 2020; 29:436-441. [DOI: 10.12968/bjon.2020.29.7.436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Patients fast routinely before elective surgery in order to reduce gastric volume and acidity. The standard fasting time is ‘nil by mouth’ from midnight before surgery. In recent years, new guidelines have recommended that patients remain nil by mouth from clear fluids for 2 hours and from solids for 6 hours. This literature review explored preoperative fasting practices in adult patients from an international perspective. Methods: A literature search was undertaken of databases, including CINAHL Plus, PubMed, Medline, the Cochrane Central Register of Controlled Trials, Science Direct, Sage Journals and Embase. Results: Anaesthetists were found to possess greater knowledge of reduced preoperative fasting than other health professionals including nurses. Conclusion: Actual fasting time was found to be relatively longer than prescribed fasting times.
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Affiliation(s)
- Lovejoy Denkyi
- MSC Clinical Leadership Capstone Project, Kingston University, London
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Morrison CE, Ritchie-McLean S, Jha A, Mythen M. Two hours too long: time to review fasting guidelines for clear fluids. Br J Anaesth 2020; 124:363-366. [PMID: 31959387 DOI: 10.1016/j.bja.2019.11.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 11/01/2019] [Accepted: 11/18/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
| | | | - Arunita Jha
- Department of Anaesthesia, National Hospital for Neurology and Neurosurgery, London, UK
| | - Monty Mythen
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK; University College London Hospitals and Great Ormond Street Hospital National Institute of Health Research Biomedical Research Centres, London, UK
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Aroni P, Fonseca LF, Ciol MA, Margatho AS, Galvão CM. The use of mentholated popsicle to reduce thirst during preoperative fasting: A randomised controlled trial. J Clin Nurs 2019; 29:840-851. [DOI: 10.1111/jocn.15138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/17/2019] [Accepted: 11/19/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Patricia Aroni
- Department of Nursing State University of Londrina Londrina Brazil
| | - Ligia F. Fonseca
- Department of Nursing State University of Londrina Londrina Brazil
| | - Marcia A. Ciol
- Department of Rehabilitation Medicine School of Medicine University of Washington Seattle WA USA
| | - Amanda S. Margatho
- General and Specialized Nursing Department Ribeirão Preto College of Nursing University of São Paulo Ribeirão Preto Brazil
| | - Cristina M. Galvão
- General and Specialized Nursing Department Ribeirão Preto College of Nursing University of São Paulo Ribeirão Preto Brazil
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Cork M, McArthur A, Douglas H, Wood F. Effectiveness and safety of perioperative enteral feeding in patients with burn injuries: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:1607-1615. [PMID: 30889069 DOI: 10.11124/jbisrir-2017-004013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to determine whether perioperative enteral feeding improves outcomes in patients with burns. INTRODUCTION Literature has identified many positive benefits of nutrition support for patients with burn injuries, including preservation of lean body mass, improved wound healing, reduced gastrointestinal permeability and enhanced immunity. Fasting for surgery can undermine the nutritional care of these patients by causing nutrient deficits. It may also negatively affect patient well-being and insulin resistance. Perioperative fasting is intended to protect patients from regurgitation and pulmonary aspiration. This research aims to investigate whether perioperative feeding impacts outcomes in patients with burn injuries. INCLUSION CRITERIA This systematic review will consider studies whose participants have a burn injury. The intervention is perioperative enteral feeding (either intragastric or post-pyloric). Patients who received perioperative feeding will be compared with patients who had enteral nutrition withheld during the perioperative period. A number of outcome measures will be investigated, including mortality, length of stay, wound infection, wound healing rate and aspiration pneumonia. METHODS The key databases searched will be PubMed, CINAHL, Embase, Web of Science and Cochrane Central Register of Controlled Trials and Scopus. Only studies published in English will be considered. There will be no date limits. Full texts of selected studies will be retrieved and assessed against inclusion criteria. Studies that do not meet the inclusion criteria will be excluded, with reasons provided. Data synthesis will be pooled in a statistical meta-analysis. Subgroup analysis will be conducted where possible. Where statistical pooling is not possible, the findings will be presented in narrative form. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018119034.
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Affiliation(s)
- Michelle Cork
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
| | - Alexa McArthur
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Helen Douglas
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
| | - Fiona Wood
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
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Wilson PB. 'I think I'm gonna hurl': A Narrative Review of the Causes of Nausea and Vomiting in Sport. Sports (Basel) 2019; 7:E162. [PMID: 31277403 PMCID: PMC6680692 DOI: 10.3390/sports7070162] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 12/27/2022] Open
Abstract
Exercise-associated gastrointestinal (GI) distress can negatively impact athletic performance and interfere with exercise training. Although there are a few universal underlying causes of GI distress, each symptom often has its own unique triggers and, therefore, its own prevention and management strategies. One of the most troubling GI symptoms an athlete can experience during training and competition is nausea/vomiting. The prevalence of nausea varies with several factors, two of the most important being exercise intensity and duration. Relatively brief, high-intensity exercise (e.g., sprinting, tempo runs) and ultra-endurance exercise are both associated with more frequent and severe nausea. The potential causes of nausea in sport are numerous and can include catecholamine secretion, hypohydration, heat stress, hyponatremia, altitude exposure, excessive fluid/food consumption, hypertonic beverage intake, pre-exercise intake of fatty- or protein-rich foods (especially in close proximity to exercise), prolonged fasting, various supplements (caffeine, sodium bicarbonate, ketones), certain drugs (antibiotics, opioids), GI infections, and competition-related anxiety. Beyond directly addressing these aforementioned causes, antiemetic drugs (e.g., ondansetron) may also be useful for alleviating nausea in some competitive situations. Given the commonness of nausea in sport and its potential impact on exercise performance, athletes and sports medicine practitioners should be aware of the origins of nausea and strategies for dealing with this troublesome gut complaint.
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Affiliation(s)
- Patrick B Wilson
- Human Movement Sciences, Old Dominion University, Norfolk, VA 23529, USA.
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King E. Preoperative fasting durations for adult elective surgical patients: Convenient for the professional, but detrimental to the patient? A narrative review. J Perioper Pract 2019; 29:393-397. [PMID: 30806189 DOI: 10.1177/1750458919832482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Preoperative fasting is necessary in reducing the risk of aspiration of stomach contents when undergoing a procedure that requires anaesthesia. There are numerous guidelines based upon evidence-based practice that outline the safe duration of a fast prior to the induction of anaesthesia. Common practice however is to give advice that unnecessarily starves the patient leading to perioperative complications. There is a breadth of literature analysing the fasting durations of various institutions, with a consensus of fasting from midnight being the norm, and side effects of nausea and dehydration being unfortunate by-products of fasting. A review of the literature examines the continued poor compliance of evidenced-based practice.
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Affiliation(s)
- Emma King
- Theatre Department, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
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Ultrasound dynamics of gastric content volumes after the ingestion of coconut water or a meat sandwich. A randomized controlled crossover study in healthy volunteers. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 30195629 PMCID: PMC9391824 DOI: 10.1016/j.bjane.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Adequate preoperative fasting is critical in preventing pulmonary aspiration of gastric content. We proposed to study the sonographic gastric content dynamics after the ingestion of liquid or solid food in healthy volunteers and confront it with current guidelines for preoperative fasting times. Methods We performed a prospective, crossover, evaluator-blinded study involving 17 healthy volunteers of both sexes. Each participant fasted for 10 h and was subjected to a baseline gastric ultrasound, intake of 400 mL of coconut water or a 145 g, 355 kcal meat sandwich, and sonographic gastric evaluations after 10 min and every hour until the stomach was completely empty. Results At baseline, all subjects had an empty stomach. At 10 min, gastric content [mean + standard deviation (SD)] was 240.4 + 69.3 and 248.2 + 119.2 mL for liquid and solid foods, respectively (p > 0.05). Mean + SD gastric emptying times were 2.5 + 0.7 and 4.5 + 0.9 h for liquid and solid foods, respectively (p < 0.001). For the drink, the stomach was completely empty in 59% and 100% of the subjects after two and four hours, and for the sandwich, 65% and 100% of the subjects after four and seven hours, respectively. Conclusions Sonographic gastric dynamics for coconut water and a meat sandwich resulted in complete gastric emptying times higher and lower, respectively, than those suggested by current guidelines for preoperative fasting.
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Stamenkovic DM, Rancic NK, Latas MB, Neskovic V, Rondovic GM, Wu JD, Cattano D. Preoperative anxiety and implications on postoperative recovery: what can we do to change our history. Minerva Anestesiol 2018; 84:1307-1317. [DOI: 10.23736/s0375-9393.18.12520-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Carmona BM, Almeida CCA, Vieira WDB, Fascio MDNC, Carvalho LRD, Vane LA, Barbosa FT, do Nascimento Junior P, Módolo NSP. [Ultrasound dynamics of gastric content volumes after the ingestion of coconut water or a meat sandwich. A randomized controlled crossover study in healthy volunteers]. Rev Bras Anestesiol 2018; 68:584-590. [PMID: 30195629 DOI: 10.1016/j.bjan.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Adequate preoperative fasting is critical in preventing pulmonary aspiration of gastric content. We proposed to study the sonographic gastric content dynamics after the ingestion of liquid or solid food in healthy volunteers and confront it with current guidelines for preoperative fasting times. METHODS We performed a prospective, crossover, evaluator-blinded study involving 17 healthy volunteers of both sexes. Each participant fasted for 10h and was subjected to a baseline gastric ultrasound, intake of 400mL of coconut water or a 145g, 355kcal meat sandwich, and sonographic gastric evaluations after 10min and every hour until the stomach was completely empty. RESULTS At baseline, all subjects had an empty stomach. At 10min, gastric content [mean + standard deviation (SD)] was 240.4 + 69.3 and 248.2 + 119.2mL for liquid and solid foods, respectively (p>0.05). Mean + SD gastric emptying times were 2.5 + 0.7 and 4.5 + 0.9h for liquid and solid foods, respectively (p<0.001). For the drink, the stomach was completely empty in 59% and 100% of the subjects after two and four hours, and for the sandwich, 65% and 100% of the subjects after four and seven hours, respectively. CONCLUSIONS Sonographic gastric dynamics for coconut water and a meat sandwich resulted in complete gastric emptying times higher and lower, respectively, than those suggested by current guidelines for preoperative fasting.
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Affiliation(s)
| | | | - Waldônio de Brito Vieira
- Fundação Santa Casa de Misericórdia do Pará, Departamento de Radiologia e Imagem de Diagnóstico, Belém, PA, Brasil
| | | | | | - Luiz Antonio Vane
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina, Botucatu, SP, Brasil
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Determination of food intake and the factors affecting food intake in perioperative period in patients who undergo open heart surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:214-222. [PMID: 32082737 DOI: 10.5606/tgkdc.dergisi.2018.15787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/05/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the factors affecting food intake in perioperative period of patients who undergo open heart surgery and the effects of body weight, albumin and hemoglobin values, nausea, vomiting and constipation on food intake. Methods This cross-sectional study was conducted between 4 February 2015 and 4 May 2015 in a cardiovascular surgery clinic. A questionnaire including 25 questions was applied to a total of 86 volunteer participants (62 males, 24 females; mean age 61.3±10.8 years; range 38 to 82 years). Results Patients consumed 38% of the food one day before the surgery and 51% one day after, 47% three days after, and 52% five days after the surgery. Factors affecting food intake were the procedure of discontinuing food intake for pre-surgery anesthesia preparation (84.9%), nausea (31.4%) one day after surgery, and constipation three (26.5%) and five (33.7%) days after surgery. Albumin levels decreased significantly in days after surgery compared to the day before surgery (p<0.05). There was a significant positive correlation between food intake rates and albumin levels on the first, third and fifth days after surgery (r=0.354, r=0.353, and r=0.521, respectively; p<0.05). Conclusion Patients' body weight and albumin levels decreased in accordance with their nourishment status after surgery. Food intake was insufficient in the perioperative period.
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Preoperative Fasting among Adult Patients for Elective Surgery in a Kenyan Referral Hospital. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2017; 2017:2159606. [PMID: 28487877 PMCID: PMC5405382 DOI: 10.1155/2017/2159606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/24/2017] [Accepted: 04/02/2017] [Indexed: 12/13/2022]
Abstract
Background. Preoperative fasting (POF) is physiologically and precautionary important during anesthesia and surgery. POF from midnight has been practiced despite the recommended shorter practice. Objective. Assessing preoperative fasting among adult patients scheduled for elective surgery at Kenyatta National Hospital (KNH). Methods. A descriptive cross-sectional study involving 65 surgical patients. A questionnaire of mixed questions on demographics, reasons, source of instructions, opinion on instructions, time, premedication practices, outcome, and complains on NPO was used. Analysis was quantitatively done with SPSS v. 22. Ethical approval was obtained from KNH-UoN ERC. Results. Of the respondents 93.8% lacked knowledge on the correct reasons for POF and felt that the instructions were unclear and less important <50%. POF instructions were administered by nurses 80%, anesthetists 15%, and surgeons 5%. Most of respondents (73.8%) fasted > 15 hours. The POF outcomes were rated moderately challenging as follows: prolonged wait for surgery 44.6%, thirst 43.1%, hunger 36.9%, and anxiety 29.2%. Conclusion. Nurses are critical in providing POF instructions and care, and patient knowledge level is a mirror reflection of the quality of interventions. This underscores the need to build capacity for nurses and strengthen the health system to offer individualized preoperative interventions as well as monitoring and clinical auditing of fasting practices.
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Martins PR, Fonseca LF, Rossetto EG. Developing and validating the Perioperative Thirst Discomfort Scale. Rev Esc Enferm USP 2017; 51:e03240. [DOI: 10.1590/s1980-220x2016029003240] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 03/21/2017] [Indexed: 11/22/2022] Open
Abstract
Abstract OBJECTIVE Developing and validating a scale to assess perioperative thirst discomfort. METHOD A methodological research conducted in 2014 and 2015 at the surgical center of a public hospital in the north of Paraná, Brazil. The scale was developed after literature review, followed by face and content validation, and reliability assessment through its internal consistency and inter-observer equivalence. RESULTS Seven items make up the scale: dry mouth; dry lips; thick tongue; thick saliva; dry throat, bad taste and desire to drink water. The content validity index for attributes and items was 0.98, and the reliability index was 1 for the scale attributes and items. Internal consistency assessed by Cronbach's alpha was 0.91 and inter-rater equivalence was 1, as measured by weighted kappa coefficient. CONCLUSION ThePerioperative Thirst Discomfort Scaleshowed high content and reliability indexes.
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