scholarly journals Preoperative fasting and prevention of pulmonary aspiration in adults: research feast, quality improvement famine

2020 ◽  
Vol 124 (4) ◽  
pp. 361-363 ◽  
Author(s):  
David W. Hewson ◽  
Iain Moppett
Keyword(s):  
Quality Improvement ◽  
Pulmonary Aspiration ◽  
Preoperative Fasting

scholarly journals A Pilot Quality Improvement Project to Reduce Preoperative Fasting Duration in Pediatric Inpatients

2019 ◽  
Vol 4 (6) ◽  
pp. e246 ◽  
Author(s):  
Allison Nye ◽  
Erin Conner ◽  
Ellen Wang ◽  
Whitney Chadwick ◽  
Juan Marquez ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Project ◽  
Preoperative Fasting ◽  
Improvement Project ◽  
Fasting Duration

scholarly journals Preoperative Fasting Practices Across Three Anesthesia Societies: Survey of Practitioners

10.2196/15905 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e15905 ◽  
Author(s):  
Richard Neville Merchant ◽  
Navraj Chima ◽  
Olle Ljungqvist ◽  
Juliana Nai Jia Kok
Keyword(s):  
Fluid Intake ◽  
Evidence Base ◽  
Pulmonary Aspiration ◽  
Internet Survey ◽  
Preoperative Fasting ◽  
Clear Fluid ◽  
Safety Issues ◽  
Solid Foods ◽  
Gastric Contents ◽  
Operating Room Schedule

Background Pulmonary aspiration of gastric contents is recognized as a complication of anesthesia. To minimize that risk, anesthesiologists advised fasting for solid foods and liquids for an often prolonged period of time. However, 30 years ago, evidence was promulgated that fasting for clear liquids was unnecessary to ensure an empty stomach. Despite a strong evidence base and the knowledge that fasting may be physiologically harmful and unpleasant for patients, the adoption of society guidelines recommending short fasting periods for clear fluids into clinical practice is uncertain. Objective This study aimed to determine the current practices of anesthetists with respect to fasting guidelines. Methods An electronic internet survey was distributed to anesthetists in Canada (CAN), Australia and New Zealand (ANZ), and Europe (EUR) during April 2014 to February 2015. The anesthetists were asked about fasting guidelines, their recommendations to patients for the consumption of clear fluids and solid foods, and the reasons and consequences if these guidelines were not followed. Results A total of 971 anesthetists completed the survey (CAN, n=679; ANZ, n=185; and EUR, n=107). Although 85.0% (818/962) of these participants claimed that their advice to patients followed current society guidelines, approximately 50.4% (476/945) enforced strict fasting and did not allow clear fluids after midnight. The primary reasons given were with regard to problems with a variable operating room schedule (255/476, 53.6%) and safety issues surrounding the implementation of clear fluid drinking guidelines (182/476, 38.2%). Conclusions Many anesthetists continue to follow outdated practices. The current interest in further liberalizing preoperative fluid intake will require more change in anesthesia culture.

Preoperative Fasting in the Pediatric Patient

2018 ◽  
Author(s):  
Nancy Hagerman ◽  
Eric Wittkugel
Keyword(s):  
Pediatric Patient ◽  
Venous Access ◽  
Pulmonary Aspiration ◽  
Evidence Based ◽  
Rare Occurrence ◽  
Preoperative Fasting ◽  
Prolonged Fasting ◽  
Gastric Contents ◽  
Difficult Venous Access ◽  
In Infants And Children

Preoperative fasting guidelines are designed to reduce the volume of gastric contents and to minimize the risk of pulmonary aspiration of gastric contents. Perioperative pulmonary aspiration in children is uncommon, with an incidence of between 1 and 10 per 10,000 anesthetics. It is associated with low morbidity and mortality. While fasting is important, it does not guarantee an empty stomach. Prolonged fasting in infants and children does not further reduce gastric volumes or increase safety but can be associated with unwanted effects such as irritability, parental dissatisfaction, hypoglycemia, dehydration, hypotension on the induction of anesthesia, difficult venous access, and possibly decreased compliance with the preoperative fast. Since pulmonary aspiration is a rare occurrence, few evidence-based recommendations for ideal fasting intervals exist. An understanding of the research involved in the creation of these guidelines is useful in ensuring the maximum safety of patients while minimizing the disadvantages of prolonged fasting.

scholarly journals Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved?

2021 ◽  
Author(s):  
Alexander R. Schmidt ◽  
James Fehr ◽  
Janice Man ◽  
Genevieve D’Souza ◽  
Ellen Wang ◽  
...  
Keyword(s):  
Median Time ◽  
Primary Outcome ◽  
Arrival Time ◽  
Task Force ◽  
Pulmonary Aspiration ◽  
Clear Liquid ◽  
Preoperative Fasting ◽  
Parental Compliance ◽  
Secondary Outcomes ◽  
American Society

Background: The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes for prolonged NPO times with the aim to suggest improvement strategies by a newly founded fasting task force.Methods: Data from all electronic anesthesia records from 2019 at our institution were reviewed for fasting times. Our NPO instructions follow American Society of Anesthesiology guidelines and are calculated based on the patient’s arrival time (90 min before OR time). Primary outcome was the effective NPO time for clear liquids, secondary outcomes were incidence of delays and the parental compliance with the NPO instructions. Data are presented as median (interquartile range).Results: 9,625 cases were included in the analysis. NPO time was documented in 72.1% with a median effective NPO time of 7:13 h (7:36). OR in room times were documented in 72.8%, 2,075 (29.5%; median time 0:10 h [0:21]) were earlier and 4,939 (70.5%; median time 0:29 h [0:54]) were later than scheduled. Parental NPO compliance showed a median deviation for clear liquid intake of 0:55 h (8:30).Conclusions: This study revealed that effective NPO times were longer than current ASA guidelines. Contributing causes include case delays and parental non-compliance to NPO instructions. Thus, task force recommendations include change NPO instruction calculations to scheduled OR time versus arrival time, and encourage parents to give their child clear liquids at the instructed time.

Case Report: The use of gastric ultrasound to assess risk of pulmonary aspiration

POCUS Journal ◽  
2016 ◽  
Vol 1 (2) ◽  
pp. 8-9
Author(s):  
James Cheng, PGY-4
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
General Anesthesia ◽  
Elective Surgery ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Aspiration ◽  
Preoperative Fasting ◽  
Patient Morbidity ◽  
Gastric Contents ◽  
American Society

Pulmonary aspiration of gastric contents is a dreaded complication of general anesthesia, as it carries significant patient morbidity and mortality. Subsequent aspiration pneumonia can lead to prolonged mechanical ventilation, and a mortality rate of up to 5%. To minimize the risk of pulmonary aspiration, patients are required – as per the American Society of Anesthesiology’s “Practice Guidelines for Preoperative Fasting” – to fast prior to elective surgery in order to ensure that the stomach is empty prior to induction of general anesthesia.

Nil by mouth: A misleading statement

2007 ◽  
Vol 17 (8) ◽  
pp. 366-371 ◽  
Author(s):  
Manish Chand ◽  
Natalie Dabbas
Keyword(s):  
General Anaesthesia ◽  
Drug Administration ◽  
Pulmonary Aspiration ◽  
Oral Medication ◽  
Junior Doctors ◽  
Preoperative Fasting ◽  
Fasting Period ◽  
Gastric Contents ◽  
Misleading Statement ◽  
Doctors And Nurses

Preoperative fasting is universally accepted as a beneficial practice to reduce the risk of pulmonary aspiration of gastric contents during the induction of general anaesthesia. What is less clear for many junior doctors and nurses is the administration of oral medication during the fasting period. This study aims to highlight the subjective understanding of the statement, ‘nil by mouth’, with regard to drug administration.

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