Development of a Safety protocol for Management Thirst in the Immediate Postoperative Period

Thirst experience and nursing needs in older patients after general anesthesia for gastrointestinal surgery: A qualitative study

BACKGROUND

Older patients often experience thirst after general anesthesia for gastrointestinal surgery, particularly during the post-anesthesia care unit (PACU) phase. Thirst not only compromises patient comfort but also induces anxiety, which may hinder recovery. Although previous studies have addressed postoperative thirst, research specifically examining thirst experiences and nursing needs in older patients remains limited.

AIM

To explore thirst experiences and nursing needs of older PACU patients following gastrointestinal surgery, aiming to inform targeted interventions.

METHODS

This study employed a phenomenological approach within a qualitative research framework. A purposeful sampling method was used to select 12 older patients who underwent gastrointestinal surgery under general anesthesia at a tertiary hospital in Shanghai between November and December 2024. Data were collected through semi-structured interviews and analyzed using Colaizzi’s seven-step method. Themes were extracted from the interview data.

RESULTS

Analysis of the interview data identified four main themes and eight subthemes: (1) Intense sensations of thirst post-surgery (subjective experience of thirst and duration of thirst); (2) Emotional experiences of thirst-related discomfort (anxiety, irritability, and helplessness); (3) Practical challenges in relieving thirst (limitations of current interventions and nursing response time); and (4) Patient expectations of nursing care (desire for more timely interventions and expectation for more proactive attention from nursing staff).

CONCLUSION

Older patients frequently experience substantial thirst discomfort after gastrointestinal surgery under general anesthesia. A multidisciplinary perioperative intervention plan is essential to alleviate these symptoms and enhance postoperative comfort.

Development of safety protocols for managing thirst in post-extubated and tracheostomized patients

to develop two distinct protocols, based on evidence, with safety criteria for post-extubated and tracheostomized patients in order to support the administration of thirst relief methods.

methodological study divided into two phases: definition of the scope and development of the protocols. Safety criteria were identified and submitted to the evaluation of reliability of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADEpro) system. The criteria were incorporated into flowcharts with their respective operational manuals. The Experts formulated recommendations and the Content Validity Index was calculated.

two protocols and its respective manuals were developed to assess the safety of the administration of thirst relief methods: one for post-extubated patients and the other for tracheostomized patients. Safety criteria listed: level of consciousness, signs of respiratory failure, nausea and/or vomiting, swallowing ability, coughing/airway protection, voice changes and adequate functioning of the tracheostomy tube. The Experts' recommendations were obtained with a Content Validity Index of 87%.

the clinical protocols, with six safety criteria each, based on evidence for the management of thirst in post-extubated and tracheostomized patients are innovative, allow safety assessment for thirst management and shows content validity.

The Effect of Oral Water and Ice Popsicle Exposure on the Management of Thirst in the Immediate Postoperative Period

PURPOSE

Thirst is a high-incidence condition that causes patients to experience problems in the early postoperative period in the postanesthesia care unit (PACU). The study was conducted to determine the effect of oral water and ice application in managing early postoperative thirst.

DESIGN

Randomized controlled trial.

METHODS

The study was conducted between January and April 2017 with 150 patients who were transferred from the operating room of a university hospital to the PACU and met the research criteria. The patients were divided into treatment (water group = 50, ice group = 50) and control (n = 50) groups. Patients in the intervention group received oral water/ice application after admission to the PACU after surgery. Patients in the control group received routine treatment and care.

FINDINGS

In intragroup comparisons before and after the application, there was a statistically significant decrease in thirst, dry mouth, dry throat, and difficulty in swallowing in the water and ice groups (P < .001); ice application was more effective than water application, and there was no significant difference in the control group (P > .05).

CONCLUSIONS

Postoperative oral water/ice application was an effective and safe nursing intervention to reduce thirst, dry mouth, dry throat, and difficulty in swallowing. Ice application was more effective.

Efficacy and Safety of Oral Hydration 1 Hour After Extubation of Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial

BACKGROUND

Thirst is one of the most common and uncomfortable symptoms in patients after cardiac surgery. The postextubation time for early oral hydration (EOH) remains unclear, and there is a lack of studies on its safety and effectiveness.

OBJECTIVE

The aim of this study was to investigate the effects of oral hydration 1 hour after extubation on thirst, salivary pH, salivary flow, oral mucosa, halitosis, gastrointestinal adverse reactions, aspiration pneumonia, and satisfaction in patients undergoing cardiac surgery.

METHODS

Eighty-four patients who underwent cardiac surgery were randomly assigned into 2 groups, for either conventional oral hydration (COH) or EOH. The EOH group drank 30 mL of warm water 1 hour post extubation and thereafter 50 mL hourly for 4 hours. The COH group had nil per os for 4 hours after extubation. If no dysphagia was evident after 4 hours, the patients were instructed to slowly drink water. Thirst intensity was evaluated every hour before the intervention. Nausea and vomiting were recorded after drinking water. The salivary pH, unstimulated salivary flow rate, oral odor, and oral mucosal moisture were evaluated at 1 hour post extubation, immediately before the intervention, and at 4 hour post intervention. Aspiration pneumonia data were collected within 72 hours post intervention. Satisfaction was assessed before leaving the intensive care unit.

RESULTS

The scores for thirst (3.38 ± 1.04; F = 306.21, P < .001), oral mucosa (2.03 ± 0.74; P < .001), and halitosis (2.77 ± 0.63; P < .001) in the EOH group were significantly lower than those in the COH group. The EOH group had significantly higher salivary pH (6.44 ± 1.06; P < .001), unstimulated salivary flow rates (0.18 ± 0.08; P < .001), and patient satisfaction (4.28 ± 0.45; P < .001) than the COH group. Nausea and vomiting did not differ significantly between groups ( P = .60). Aspiration pneumonia was not observed in either group.

CONCLUSIONS

Oral hydration 1 hour after extubation significantly alleviated thirst and stabilized the oral environment without gastrointestinal adverse reactions or aspiration pneumonia, and with increased patient satisfaction.

Nurses' Recognition and Care of Thirst in Perioperative Patients in Japan

PURPOSE

Postoperative thirst is common and distressing to patients, as is pain and nausea. The causes of postoperative thirst are complex and include factors like preoperative fasting, perioperative fluid loss, and certain anesthesia medications. Effective care for postoperative thirst has been shown in post-anesthesia care units (PACUs), but many Japanese hospitals lack PACUs or do not address thirst in their PACUs. Therefore, cooperation between the operating room and ward nurses is crucial for providing proper care for postoperative thirst. The purpose of this study was to clarify the actual situation of ward nurses' and operating room nurses' recognition and care of thirst in postoperative patients.

METHODS

The study was a cross-sectional survey conducted using a self-administered questionnaire based on previous research. Study participants were nurses working in surgical wards and operating rooms of two university-affiliated hospitals. The survey items included (1) participants' characteristics, (2) recognition of thirst in perioperative patients, and (3) actual care provided to perioperative patients for thirst. Data were collected between September and October 2022 and subjected to descriptive and bivariate analysis.

FINDINGS

A total of 298 ward nurses and 43 operating room nurses were included in the study. Among the observation items, thirst was observed least frequently. Both ward nurses and operating room nurses recognized patient thirst based on complaints rather than physical observations. Sharing of information about patient thirst differed between ward nurses and operating room nurses. None of the participants used scales or scores to evaluate thirst. The most common postoperative care in the ward was "They were asked to do a mouthwash with water," while in the operating room, it was "Placed a moistened gauze against the mouth." The reasons for selecting a particular type of care were primarily based on "Because of the patient's wishes" and "I think it is effective," while the reasons for not providing care included "Because there is an instruction not to drink water," "Due to the possibility of aspiration," "I don't have the knowledge and don't know how," and "I'm busy with other work."

CONCLUSIONS

Regarding the recognition of thirst, both ward nurses and operating room nurses recognized patient thirst most often when the patient directly reported feeling thirsty. They relied more on patients' verbal complaints than physical observations to recognize thirst. Both surgical ward nurses and operating room nurses provided care based on their experience.

Exploring thirst incidence and risk factors in patients undergoing general anesthesia after extubation based on ERAS principles: a cross sectional study

BACKGROUND

This study aims to comprehend the levels of dry mouth and thirst in patients after general anesthesia, and to identify the factors influencing them.

METHODS

The study included all patients transferred to the Post Anesthesia Care Unit (PACU) at the Second Affiliated Hospital of Dalian Medical University between August 2021 and November 2021 after undergoing general anesthesia. A thirst numeric rating scale was utilized to conduct surveys, enabling the assessment of thirst incidence and intensity. Statistical analysis was performed to explore patient thirst levels and the associated factors.

RESULTS

The study revealed a thirst incidence rate of 50.8%. Among the thirst intensity ratings, 71.4% of patients experienced mild thirst, 23.0% reported moderate thirst, and 5.6% expressed severe thirst. Single-factor statistical analysis of potential risk factors among the enrolled cases indicated that gender, history of coronary heart disease, surgical duration, intraoperative fluid volume, intraoperative blood loss, intraoperative urine output, and different surgical departments were linked to post-anesthetic thirst in patients undergoing general anesthesia. Multifactorial Logistic regression analysis highlighted age, gender, history of coronary heart disease, fasting duration, and intraoperative fluid volume as independent risk factors for post-anesthetic thirst in patients undergoing general anesthesia. Moreover, age, gender, history of coronary heart disease, and intraoperative fluid volume were also identified as risk factors for varying degrees of thirst.

CONCLUSION

The incidence and intensity of post-anesthetic thirst after general anesthesia are relatively high. Their occurrence is closely associated with age, gender, history of coronary heart disease, fasting duration, and intraoperative fluid volume.

Safety and feasibility of early drinking water after general anesthesia recovery in patients undergoing daytime surgery

BACKGROUND

Patients who are recovering from general anesthesia commonly exhibit symptoms such as dry lips, throat irritation, and thirst, prompting a desire to drink water in the post-anesthesia care unit (PACU). In this study, we aimed to evaluate the therapeutic effects and any potential complications of administering varying quantities of water to such patients. The primary objectives are to assess the safety and feasibility of early water intake after general anesthesia, specifically in the context of daytime surgery.

METHODS

A total of 200 nongastrointestinal patients who underwent outpatient surgery were randomly assigned to four groups: Group A (drinking < 1 ml/kg), Group B (drinking 1-2 ml/kg), Group C (drinking > 2 ml/kg), and Group D (no water intake). We monitored changes in the assessment parameters before and after water consumption, as well as the incidence of post-drinking nausea and vomiting, and compared these outcomes among the four groups.

RESULTS

Water intake led to a significant reduction in thirst, oropharyngeal discomfort, and pain scores and a notable increase in the gastric antrum motility index (MI), exhibiting statistical significance compared to the values before drinking (p < 0.05). Remarkably, higher water consumption correlated with enhanced gastrointestinal peristalsis. There was a significant difference in the antral MI among groups B, C, and A (p < 0.05). The occurrence of nausea and vomiting did not significantly differ among groups A, B, C, and D (p > 0.05). Early water consumption enhanced patient satisfaction with medical care, significantly varying from Group D (p < 0.05).

CONCLUSION

Non-gastrointestinal surgical patients who passed pre-drinking water assessments post GA(general anesthesia)recovery could safely ingest moderate amounts of water in the PACU. Early water intake is both safe and feasible, effectively fostering swift postoperative recovery.

Timing of early water intake post-general anaesthesia: a systematic review and meta-analysis

BACKGROUND

Early water intake has gained widespread attention considering enhanced recovery after surgery (ERAS). In the present systematic evaluation and meta-analysis, we assessed the effects of early water intake on the incidence of vomiting and aspiration in adult patients who received general anaesthesia on regaining consciousness during the resuscitation period.

OBJECTIVE

To systematically analyse the results of randomised controlled trials on early postoperative water intake in patients who underwent different types of surgery under general anaesthesia, both at home and abroad, to further explore the safety and application of early water intake and provide an evidence-based foundation for clinical application.

DESIGN

Systematic review and meta-analysis.

METHODS

To perform the systematic evaluation and meta-analysis, we searched the Web of Science, CINAHL, Embase, PubMed, Cochrane Library, Sinomed, China National Knowledge Infrastructure (CNKI), Wanfang, and Vipshop databases to identify randomised controlled trial studies on early water intake in adult patients who received general anaesthesia.

RESULTS

Herein, we included 10 publications with a total sample size of 5131 patients. Based on statistical analysis, there was no statistically significant difference in the incidence of vomiting (odds ratio [OR] = 0.81; 95% confidence interval [CI] [0.58-1.12]; p = 0.20; I-squared [I2] = 0%) and aspiration (OR = 0.78; 95%CI [0.45-1.37]; p = 0.40; I2 = 0%) between the two groups of patients on regaining consciousness post-general anaesthesia.

CONCLUSION

Based on the available evidence, early water intake after regaining consciousness post-anaesthesia did not increase the incidence of adverse complications when compared with traditional postoperative water abstinence. Early water intake could effectively improve patient thirst and facilitate the recovery of gastrointestinal function.

Neural Mechanisms Underlying the Coughing Reflex

Breathing is an intrinsic natural behavior and physiological process that maintains life. The rhythmic exchange of gases regulates the delicate balance of chemical constituents within an organism throughout its lifespan. However, chronic airway diseases, including asthma and chronic obstructive pulmonary disease, affect millions of people worldwide. Pathological airway conditions can disrupt respiration, causing asphyxia, cardiac arrest, and potential death. The innervation of the respiratory tract and the action of the immune system confer robust airway surveillance and protection against environmental irritants and pathogens. However, aberrant activation of the immune system or sensitization of the nervous system can contribute to the development of autoimmune airway disorders. Transient receptor potential ion channels and voltage-gated Na+ channels play critical roles in sensing noxious stimuli within the respiratory tract and interacting with the immune system to generate neurogenic inflammation and airway hypersensitivity. Although recent studies have revealed the involvement of nociceptor neurons in airway diseases, the further neural circuitry underlying airway protection remains elusive. Unraveling the mechanism underpinning neural circuit regulation in the airway may provide precise therapeutic strategies and valuable insights into the management of airway diseases.

Use of a menthol popsicle in managing postoperative thirst in patients undergoing radical prostatectomy: A randomized clinical trial

Background and aim: Thirst is a real bother that most patients feel in the immediate postoperative period when they still need to fast. Many approaches regarding symptomatic relief strategies have been described in the literature, but strategies with cold water and/or menthol are effective in quenching thirst, as they act on pre-absorptive mechanisms. This study aims to evaluate the effectiveness of using menthol popsicles in relieving postoperative thirst in patients undergoing radical prostatectomy. Material and methods: This is a randomized controlled clinical trial with a quantitative approach. In all, 44 patients were evaluated in the immediate postoperative period of radical prostatectomy, with the intensity and discomfort of thirst being evaluated initially and subsequently. The study consisted of two groups: (1) the placebo group, popsicles without the addition of menthol substrates and (2) the experimental group, popsicles with the addition of 0.05% minty substrates. Results: The results demonstrate that the sociodemographic and clinical characteristics were homogeneous at the α = 5% significance level, except the occupation variable. The test detected changes in the intensity and discomfort of thirst in relation to the pre- and post-intervention times for the primary outcome when the groups were analyzed separately and for the interaction of the group versus time, there was no statistical difference between the groups. Conclusion: It was possible to prove that both the menthol popsicle and the popsicle without the addition of menthol were effective in relieving postoperative thirst in patients undergoing radical prostatectomy, but there was no statistically significant difference when comparing the two groups. Trial registration: The Brazilian Registry of Clinical Trials (RBR-8c3chr7).

Prevalence, risk factors, and optimized management of moderate-to-severe thirst in the post-anesthesia care unit

Post-operative thirst is common and may cause intense patient discomfort. The aims of this retrospective study conducted in a high-volume post-anesthesia care unit (PACU) were as follows: (1) to examine the prevalence of moderate-to-severe post-operative thirst—defined as a numerical rating scale (NRS) score of 4 or higher, (2) to identify the main risk factors for moderate-to-severe post-operative thirst, and (3) to maximize the efficacy and safety of thirst management through a quality improvement program. During a 1-month quality improvement program conducted in August 2018, a total of 1211 adult patients admitted to our PACU were examined. Moderate-to-severe thirst was identified in 675 cases (55.8%). The use of glycopyrrolate during anesthesia was associated with moderate-to-severe thirst (71.7% versus 66.4%, respectively, p = 0.047; adjusted odds ratio: 1.46, p = 0.013). Following a safety assessment, ice cubes, room temperature water, or an oral moisturizer were offered to patients. A generalized estimating equation model revealed that ice cubes were the most effective means for thirst management—resulting in an estimated thirst intensity reduction of 0.93 NRS points at each 15-min interval assessment (p < 0.001)—followed by room temperature water (− 0.92/time-point, p < 0.001) and the oral moisturizer (− 0.60/time-point; p < 0.001). Patient satisfaction (rated from 1 [definitely dissatisfied] to 5 [very satisfied]) followed a similar pattern (ice cubes: 4.22 ± 0.58; room temperature water: 4.08 ± 0.55; oral moisturizer: 3.90 ± 0.55, p < 0.001). The use of glycopyrrolate—an anticholinergic agent that reduces salivary secretion—was the main independent risk factor for moderate-to-severe post-operative thirst. Our findings may provide clues towards an optimized management of thirst in the immediate post-operative period.

Elaboration, validation and reliability of the safety protocol for pediatric thirst management

Objective:

to elaborate, validate and evaluate the reliability of the Safety Protocol for Pediatric Thirst Management in the immediate postoperative period.

Method:

methodological quantitative research, based on the assumptions on measurement instrument development. The protocol was elaborated after literature review, interview with specialists and observation of the child’s anesthetic recovery. The judges performed theoretical validation through apparent, semantic and content analysis. Content Validity Index was calculated for content validation, whose minimum established concordance was 0.80. Protocol’s reliability was evaluated in children between three and 12 years old in the Post Anesthesia Care Unit.

Results:

in its final version, the protocol consisted of five evaluation criteria: level of consciousness, movement, airway protection, breathing pattern and nausea and vomiting. It presented easy comprehension and relevant content, and all indexes exceeded the minimum agreement of 0.80. Pairs of nurses applied the protocol 116 times to 58 children, resulting in a high reliability index (kappa general = 0.98)

Conclusion:

the unprecedented protocol developed is valid and is a useful tool for use in anesthetic recovery, aiming to assess safety for reducing the thirst of infant patients.

Evaluation of a Safety Protocol for the Management of Thirst in the Postoperative Period

PURPOSE

To associate medications, anesthetic techniques, and clinical conditions that interfere in the time of patient approval in the safety protocol for thirst management.

DESIGN

A quantitative, analytical, and longitudinal study conducted in Southern Brazil.

METHODS

A nonprobabilistic sample, of 203 adult patients in the immediate postoperative period, evaluated every 15 minutes for 1 hour.

FINDINGS

A general prevalence of thirst of 67.7%, and mean intensity of 6.38. Fentanyl, morphine, rocuronium, and sevoflurane increased lack of approval in the protocol within 30 minutes (P < .05). General anesthesia (P < .0001) and level of consciousness (95.4%) presented the highest nonapproval rates.

CONCLUSIONS

Anesthetics and general anesthesia delayed protocol approval; however, after 30 minutes, 75.4% of patients had been approved. Level of consciousness was the main criterion of disapproval. The protocol identified crucial clinical conditions that made it impossible for the patient to receive thirst relief strategies and demonstrated that thirst can be satiated precociously with safety.

Evaluation of the intensity and discomfort of perioperative thirst

Abstract Objective: To evaluate the intensity and discomfort of perioperative thirst and related factors during anesthesia recovery. Method: This is a quantitative, cross-sectional, descriptive study. Results: Of the 203 participants, 182 (89.6%) reported they were thirsty. The mean intensity of thirst was 6.9 measured using a verbal numerical scale of 0 to 10 and discomfort was 7.3 on a scale of 0 to 14. All attributes evaluated by the scale were cited including dry mouth and desire to drink water (87.3%), dry lips (79.1%), thick tongue feeling (43.4%), thick saliva (56.5%), dry throat (75.2%) and bad taste in the mouth (63.1%). There was a positive correlation between the intensity of thirst and discomfort assessed by the scale (Spearman coefficient: 0.474; p-value: <0.05). No correlation was found between age, length of fasting and use of opioids with the intensity of thirst and discomfort. Conclusion and implication in the clinical practice: Discomfort arising from the attributes of thirst is evidenced as the intensity of thirst increases.

Perioperative thirst: an analysis from the perspective of the Symptom Management Theory

A theoretical study aimed to analyze the existing knowledge in the literature on the perioperative thirst symptom from the perspective of Symptom Management Theory, and supplemented with the experience of the study group and thirst research. Thirst is described as a very intense symptom occurring in the perioperative period, and for this reason it cannot be ignored. The Symptom Management Theory is adequate for understanding the thirst symptom and is a deductive theory, focused on the domains of the Person, Environment and Health / Illness Status, as well as on the dimensions of Experience, Management Strategies and Symptom Outcomes. Using the theory leads us to consider perioperative thirst in its multifactorial aspects, analyzing the interrelation of its domains and dimensions in order to draw attention to this symptom that has been insufficiently valued, recorded and treated in clinical practice.