Preoperative fasting: a clinical audit

Preoperative fasting durations for adult elective surgical patients: Convenient for the professional, but detrimental to the patient? A narrative review

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.

The introduction of an enhanced recovery pathway for elective caesarean sections

This article will focus on the establishment of an enhanced recovery pathway (ERP) for women undergoing elective caesarean section in a busy maternity unit. It will consider the background to this project, the impact on services and the improvements in service that have been achieved as well as the challenges that have been experienced in this process.

Preoperative fasting times in elective surgical patients at a referral Hospital in Botswana

Introduction

Adults and children are required to fast before anaesthesia to reduce the risk of regurgitation and aspiration of gastric contents. However, prolonged periods of fasting are unnecessary and may cause complications. This study was conducted to evaluate preoperative fasting period in our centre and compare it with the ASA recommendations and factors that influence fasting periods.

Methods

This is a cross-sectional study of preoperative fasting times among elective surgical patients. A total numbers of 260 patients were interviewed as they arrived at the reception area of operating theatre using questionnaire.

Results

Majority of patients (98.1%) were instructed to fast from midnight. Fifteen patients (5.8%) reported that they were told the importance of preoperative fasting. The mean fasting period were 15.9±2.5 h (range 12.0-25.3 h) for solids and 15.3±2.3 h (range 12.0-22.0 h) for liquids. The mean duration of fasting was significantly longer for patients operated after midday compared to those operated before midday, p<0.001.

Conclusion

The mean fasting periods were 7.65 times longer for clear liquid and 2.5 times for solids than the ASA guidelines. It is imperative that the Hospital should establish Preoperative fasting policies and teach the staff who should ensure compliance with guidelines.

Improved patient education facilitates adherence to preoperative fasting guidelines

Preoperative fasting is recognised as an important factor in perioperative patient care. Implementation of guidelines on preoperative fasting remains sub-optimal. We audited perioperative fasting in a district general hospital, implemented changes to the preoperative information leaflet and improved fasting practices. The manner in which information is presented to patients impacts behavior and adherence to recommendations. Improving this domain of clinical practice requires thorough and conscious effort and repeated reassessment.