1
|
Lu Y, Liu S, Jing S, Zhao X, Liang J, Sun X, Lin Y. Safety and feasibility of early drinking water after general anesthesia recovery in patients undergoing daytime surgery. BMC Anesthesiol 2024; 24:231. [PMID: 38987679 PMCID: PMC11234596 DOI: 10.1186/s12871-024-02615-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Yixing Lu
- Department of Anesthesiology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, No. 225 Xinyang Road, Nanning, 530003, China
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, China
| | - Siyan Liu
- Department of Anesthesiology, Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shunzhong Jing
- Department of Anesthesiology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, No. 225 Xinyang Road, Nanning, 530003, China
| | - Xuefeng Zhao
- Department of Anesthesiology, the First People's Hospital of Yulin, Yulin, China
| | - Jiamei Liang
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, China
| | - Xiaoqiang Sun
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, China
| | - Yunan Lin
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, China.
| |
Collapse
|
2
|
Xue Y, Wang Q, Zhao H, Pan R, Xia Y, Wang H, Qin X. The efficacy and safety of modified ultraearly oral hydration for alleviating thirst in patients after thoracoscopic surgery: a prospective randomized controlled trial. BMC Anesthesiol 2024; 24:105. [PMID: 38504189 PMCID: PMC10949755 DOI: 10.1186/s12871-024-02497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE Postoperative fasting following thoracoscopic surgery can cause intense thirst and oral discomfort. However, there is currently no research on ultraearly oral hydration (UEOH) in middle-aged or elderly patients after thoracoscopic surgery. The aim of this study was to investigate the effectiveness and safety of UEOH for improving oral discomfort after thoracoscopic surgery. METHODS This single-center prospective double-blind randomized controlled trial was conducted from April 2022 to November 2023. A total of 64 middle-aged and elderly patients who underwent the first thoracoscopic surgery on the day were enrolled at our institution. Postoperatively, in the Postanesthesia Care Unit (PACU), patients were randomly assigned at a 1:1 ratio to either the UEOH group or the standard care (SC) group. The primary outcome was the patient's thirst score at 6 h after surgery. Secondary outcomes included the incidence of postoperative oral discomfort; pain scores; the occurrence of adverse reactions such as nausea, vomiting, regurgitation and aspiration; anxiety scores on the first postoperative day; the time to first flatus; and recovery satisfaction scores. RESULTS The demographic and surgical characteristics were similar between the two groups. Patients in the UEOH group had lower thirst scores 6 h after surgery than did those in the SC group(16.1 ± 6.70 vs. 78.4 ± 8.42, P < 0.01). The incidence of postoperative oral discomfort (P < 0.01), anxiety scores on the first postoperative day (P<0.05), and time to first flatus (P<0.05) were better in the UEOH group. Additionally, the incidences of adverse reactions, such as postoperative nausea, vomiting, regurgitation and aspiration, were similar between the two groups (P>0.05). CONCLUSION For middle-aged and elderly patients undergoing thoracoscopic surgery, the use of a modified UEOH protocol postoperatively can improve thirst and promote gastrointestinal recovery without increasing complications. TRIAL REGISTRATION This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 07/12/2023 with the registration number ChiCTR2300078425.
Collapse
Affiliation(s)
- Yan Xue
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Qian Wang
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Hongyu Zhao
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Ren Pan
- Department of Pain Management, Dongguan Songshan LakeCentral Hospital, Dongguan, 523320, Guangdong Province, China
| | - Yanfei Xia
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Hongmei Wang
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Xiarong Qin
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China.
| |
Collapse
|
3
|
do Nascimento LA, Conchon MF, Garcia AKA, Lopes MVDO, Fonseca LF. Clinical validation of the nursing diagnostic proposition perioperative thirst. Rev Lat Am Enfermagem 2023; 31:e3974. [PMID: 37556617 PMCID: PMC10408248 DOI: 10.1590/1518-8345.6621.3974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/28/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE to verify the clinical validity of the proposition of a new nursing diagnosis called perioperative thirst, based on the diagnostic accuracy of its clinical indicators, including the magnitude of effect of its etiological factors. METHOD clinical diagnostic validation study with a total of 150 surgical patients at a university hospital. Sociodemographic variables and clinical indicators related to thirst were collected. The latent class analysis technique was used. RESULTS two models of latent classes were proposed for the defining characteristics. The model adjusted preoperatively included: dry lips, thick saliva, thick tongue, desire to drink water, caregiver report, dry throat and constant swallowing of saliva. In the postoperative period: dry throat, thick saliva, thick tongue, constant swallowing of saliva, desire to drink water, bad taste in the mouth. The factors related to "high ambient temperature" and "dry mouth" are associated with the presence of thirst, as well as the associated conditions "use of anticholinergics" and "intubation". The prevalence of thirst was 62.6% in the pre and 50.2% in the immediate postoperative period. CONCLUSION the diagnostic proposition of perioperative thirst showed good accuracy parameters for its clinical indicators and etiological effects. This proposition in a nursing taxonomy will allow greater visibility, appreciation and treatment of this symptom.(1) Evaluates the accuracy of the proposition of the nursing diagnosis perioperative thirst; (2) Allows refined diagnosis for use in clinical practice, teaching and research; (3) Strengthens the systematization of perioperative nursing care; (4) Highlights thirst management as part of care, considering its high prevalence and discomfort; (5) Presents a structure with good accuracy parameters which are representative of thirst.
Collapse
Affiliation(s)
| | | | | | | | - Lígia Fahl Fonseca
- Universidade Estadual de Londrina, Departamento de Enfermagem, Londrina, PR, Brasil
| |
Collapse
|
4
|
Ma F, He H, Xu B, Zhou J, Pu K. Effect of sterile ice water versus menthol spray on thirst symptoms of fasted children in the intensive care unit: A prospective cohort study. Medicine (Baltimore) 2023; 102:e33315. [PMID: 36961147 PMCID: PMC10036011 DOI: 10.1097/md.0000000000033315] [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: 10/17/2022] [Accepted: 02/27/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Thirst is a very common symptom in fasted children in intensive care unit (ICU). This study aimed to evaluate the effect of sterile ice water versus menthol spray in ICU fasted children, to provide insights to the clinical care of fasted children. METHODS The children admitted to the ICU of our hospital from June 1, 2021 to August 31, 2022 and needed to fast were included. Children were randomly assigned to the ice water group or menthol group. We evaluated and compared the thirst distress scale (TDS), oral mucosa wetness scale (OMWS), children medical fear scale (CMFS), numerical rating scale (NRS), unstimulated whole saliva (UWS) flow rate between 2 groups. RESULTS A total of 139 children were included, involving 69 children in ice water group and 70 children in menthol group. There were no significant differences in the baseline characteristics, TDS, OMWS, OMWS, CMFS, and NRS score, UWS flow rate before intervention between ice water group and menthol group (all P > .05). After intervention, the TDS, OMWS, NRS score of menthol group was statistically less than that of ice water group (all P < .05), the UWS flow rate of menthol group was statistically higher than that of ice water group (P = .034). CONCLUSIONS Compared with ice water spray, menthol spray may be more beneficial to relieve the thirst and increase the comfort in ICU fasted children. Future studies with larger sample size and rigorous design are needed to evaluate the effects and safety of ice water and menthol spray in the nursing care of children.
Collapse
Affiliation(s)
- Fangyan Ma
- Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Haiting He
- Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Banghong Xu
- Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Zhou
- Department of Nursing, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Pu
- Department of Nursing, Children’s Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
5
|
Liang T, Li SL, Peng YC, Chen Q, Chen LW, Lin YJ. Efficacy and Safety of Oral Hydration 1 Hour After Extubation of Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial. J Cardiovasc Nurs 2022; Publish Ahead of Print:00005082-990000000-00044. [PMID: 36730988 DOI: 10.1097/jcn.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
Collapse
|
6
|
Sun ZJ, Sun X, Huo Y, Mi M, Peng GL, Zhang CL, Jiang Y, Zhou Y, Zhao X, Li T, Wu XB. Abbreviated perioperative fasting management for elective fresh fracture surgery: guideline adherence analysis. BMC Musculoskelet Disord 2022; 23:688. [PMID: 35858882 PMCID: PMC9297612 DOI: 10.1186/s12891-022-05574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term fasting for elective surgery has been proven unnecessary based on established guidelines. Instead, preoperative carbohydrate loading 2 h before surgery and recommencing oral nutrition intake as soon as possible after surgery is recommended. This study was performed to analyze the compliance with and effect of abbreviated perioperative fasting management in patients undergoing surgical repair of fresh fractures based on current guidelines. METHODS Patients with fresh fractures were retrospectively analyzed from the prospectively collected database about perioperative managements based on enhanced recovery of surgery (ERAS) from May 2019 to July 2019 at our hospital. A carbohydrate-enriched beverage was recommended up to 2 h before surgery for all surgical patients except those with contraindications. Postoperatively, oral clear liquids were allowed once the patients had regained full consciousness, and solid food was allowed 1 to 2 h later according to the patients' willingness. The perioperative fasting time was recorded and the patients' subjective comfort with respect to thirst and hunger was assessed using an interview-assisted questionnaire. RESULTS In total, 306 patients were enrolled in this study. The compliance rate of preoperative carbohydrate loading was 71.6%, and 93.5% of patients began ingestion of oral liquids within 2 h after surgery. The median (interquartile range) preoperative fasting time for liquids and solids was 8 (5.2-12.9) and 19 (15.7-22) hours, respectively. The median postoperative fasting time for liquids and solids was 1 (0.5-1.9) and 2.8 (2.2-3.5) hours, respectively. A total of 70.3% and 74.2% of patients reported no thirst and hunger during the perioperative period, respectively. Logistic regression analysis showed that the preoperative fasting time for liquids was an independent risk factor for perioperative hunger. No risk factor was identified for perioperative thirst. No adverse events such as aspiration pneumonia or gastroesophageal reflux were observed. CONCLUSIONS In this study of a real clinical practice setting, abbreviated perioperative fasting management was carried out with high compliance in patients with fresh fractures. The preoperative fasting time should be further shortened to further improve patients' subjective comfort.
Collapse
Affiliation(s)
- Zhi-Jian Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Xu Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yan Huo
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Meng Mi
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Gui-Ling Peng
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Chun-Ling Zhang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yao Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yan Zhou
- Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Xia Zhao
- Department of Nutriology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Ting Li
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Xin-Bao Wu
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| |
Collapse
|