scholarly journals Preoperative fasting in the department of plastic surgery

2018 ◽  
Vol 7 (4) ◽  
pp. e000161 ◽  
Author(s):  
Andrew Davies ◽  
Wei Sheng Pang ◽  
Timothy Fowler ◽  
Ffion Dewi ◽  
Thomas Wright
Keyword(s):  
Plastic Surgery ◽  
Preoperative Assessment ◽  
Solid Food ◽  
General Anaesthetic ◽  
Preoperative Fasting ◽  
Gastrointestinal Complications ◽  
Fasting Time ◽  
Assessment Sheet ◽  
The Mean ◽  
Clear Information

Preoperative fasting is necessary to reduce the risk of regurgitation of gastric contents and pulmonary aspiration in patients undergoing general anaesthetic and procedural sedation. Excessive fasting is associated with metabolic, cardiovascular and gastrointestinal complications and patient discomfort. We aimed to reduce the fasting time for patients on the plastic surgery trauma list. Adult inpatients awaiting surgery were asked to complete a preoperative assessment sheet. Questions included the length of preoperative fasting, clarity of instructions and wellness scores. Three cycles of data collection were performed over a 12-month period, patients who declined to participate or were unable to consent were excluded. The first cycle revealed the need for significant improvement. Interventions included staff education, patient information sheets, preoperative drinks, greater availability of ward snacks and improved communication between the ward staff and surgical team through our electronic trauma database. The initial audit of 15 patients revealed a mean fasting time of 16.3 hours for fluid (range 10–22) and a mean of 19.3 hours for solid food (range 10–24). The mean wellness score was 6/10 (10 being very well), 67% of patients felt they were given clear information. The final cycle demonstrated clear improvement in all domains. The mean fasting time declined to 5.1 hours for fluid (range 3–10 hours) and 13 hours for solid food (range 7.5–17 hours). The mean wellness score (10=very well) increased from 6 to 8, the mean thirst score declined from 6.1 to 5.1 and 100% patients felt they had been given clear information. Removal of the traditional ‘NBM from midnight’, patient education, a clear fasting routine with preoperative drinks and improved communication between the full multidisciplinary team has led to a reduction in the fasting times on our trauma list.

Incidence of urinary ketosis and the effect of carbohydrate drink supplementation during fasting for elective caesarean section: Audit

2021 ◽  
pp. 175045892110090
Author(s):  
Hannah Bellwood ◽  
Kellie M Rozdarz ◽  
John Riordan
Keyword(s):  
Caesarean Section ◽  
Elective Caesarean Section ◽  
Caloric Intake ◽  
Preoperative Fasting ◽  
Lower Segment ◽  
Lower Segment Caesarean Section ◽  
Fasting Time ◽  
Before And After ◽  
The Mean

Elective lower segment caesarean section patients are routinely instructed to fast from food for 6h before surgery, with clear fluids up until 2h before surgery. We conducted an audit examining the true fasting times of mothers undergoing an elective caesarean section and the incidence of urinary ketones before and after introducing a preop carbohydrate drink (Nutricia preOp 400ml) to be administered to all patients at 6am on the day of surgery. We audited 50 patients prior to introducing the preop carbohydrate drink and 54 patients after the introduction of a carbohydrate drink. We found the mean fasting time from last caloric intake was reduced from 13h 35min to 5h 5min after the introduction of a preoperative carbohydrate drink. We found that the incidence of urinary ketones was 40.4% prior to the introduction of a preoperative carbohydrate drink and 38.3% after the introduction of a preop drink (p = 1). If fasting times were limited to under 4h, the incidence of urinary ketones is 10%. Our audit demonstrates that reducing preoperative fasting times is possible and preventing metabolic derangements may be possible, requiring an approach targeted at keeping fasting times to a minimum.

scholarly journals The effect of preoperative fasting to postoperative agitation, nausea, and vomiting in children with tonsillectomy

2021 ◽  
Vol 8 (6) ◽  
pp. 394-400
Author(s):  
Şahsine Özdemir ◽  
Eda Dolgun
Keyword(s):  
Nausea And Vomiting ◽  
Spearman Correlation ◽  
Preoperative Fasting ◽  
Fasting Period ◽  
Surgical Nurses ◽  
Significant Difference ◽  
Fasting Time ◽  
Package Program ◽  
Spearman Correlation Test ◽  
The Mean

Objective: This study was conducted to investigate the effect of preoperative fasting period on postoperative agitation, nause and vomiting in children with tonsillectomy. Material and Methods: Children (n:123) who have had tonsillectomy between June and December 2017 and their families have taken place in the study. The data were collected by the researchers with a questionnaire. The data were analyzed using the SPSS 18 package program and with descriptive, Mann Whitney U test, Spearman Correlation test. Results: The mean duration of preoperative fasting was 11.03±1.17 hours, the duration of thirst was 10.17±1.00 hours. The mean behavior scores of the children were 1.28±0.27 points, the mean vomiting score of the children was 0.01±0.07 points, 56.9% of the children in the postoperative unit were not experiencing nausea. Between duration of preoperative fasting with agitation and vomiting status in postoperative unit was found to statistically no relationship. According to preoperative fasting time of children, a statistically significant difference was found when children were diagnosed as having or not having symptoms of nausea. Conclusıon: It was found that the children had longer duration of preoperative fasting than the guidelines suggested in the guidelines. It was observed that pre-operative fasting time did not affect postoperative agitation and vomiting, but it affected nausea. Practice Implications: Surgical nurses should emphasize the importance of fasting period to families before surgery and inform families on this issue.  

741 Manipulation and Reduction of Paediatric Forearm Fractures in The Emergency Department Using Intranasal Diamorphine and Entonox

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Kapoor ◽  
A Valand ◽  
J Dartnell
Keyword(s):  
Emergency Department ◽  
Patient Discharge ◽  
General Anaesthetic ◽  
Forearm Fractures ◽  
Distal Radial Fractures ◽  
Access To Treatment ◽  
Early Access ◽  
The Mean ◽  
Salter Harris

Abstract Background Paediatric forearm fractures are commonly encountered in Trauma and Orthopaedics. Currently most forearm fractures are manipulated in theatre the following day, increasing resource burden and delays in management. The aim of this project was to introduce guidelines to reduce fractures in the Emergency Department (ED) using intranasal Diamorphine and Entonox. Method 197 cases were identified over a 6-month period in 2018 and 2019. 74 distal radial fractures and 123 mid shaft forearm fractures were analysed. Fractures with an intact periosteal hinge or a Salter Harris type 2 were reduced in ED. The pre manipulation and post manipulation radiographs were compared with particular attention to the post reduction angles. Results 67% of fractures were reduced in the correct setting. A number of fractures reduced in ED required re-manipulation or internal fixation. Overall, there was a 56% reduction in patients undergoing general anaesthetic. There was a reduction in the mean length of stay from 36 hours to 3.5 hours. Conclusions Intranasal Diamorphine and Entonox offer a safe method for managing paediatric forearm fractures in ED. Implementation of this method facilitates early access to treatment and early patient discharge. Manipulation in ED offers significant financial savings and reduces demands on the Trauma Theatres.

scholarly journals Three-dimensional analysis of acetabular cup orientation and an evaluation of the relationship with pelvic sagittal parameters

2019 ◽  
Vol 27 (2) ◽  
pp. 230949901986122
Author(s):  
Ali Sahin ◽  
Mehmet Emin Simsek ◽  
Safa Gursoy ◽  
Mustafa Akkaya ◽  
Cetin Isik ◽  
...  
Keyword(s):  
Pelvic Tilt ◽  
Three Dimensional ◽  
Preoperative Assessment ◽  
Statistical Correlation ◽  
Acetabular Cup ◽  
Pelvic Parameters ◽  
Sagittal Parameters ◽  
The Mean ◽  
The Difference ◽  
The Relationship

Background: This study aimed to evaluate the effect of total hip arthroplasty (THA) on sagittal pelvic parameters and to evaluate the effect of sagittal pelvic parameters on acetabular cup orientation. Methods: The study included 86 patients who underwent THA for a diagnosis of unilateral coxarthrosis between 2011 and 2015. Measurements were taken of the preoperative and postoperative acetabular cup inclination (ACI), anteversion, and sagittal pelvic parameters. The effect of THA on sagittal pelvic parameters and the effects of the sagittal pelvic parameters on acetabular cup orientation were investigated. Results: The sagittal pelvic tilt values calculated were mean 9.7° ± 6.3° (2°; 23°) preoperatively and 11.0° ± 6.1° (2°; 25°) postoperatively. The increase in postoperative pelvic incidence (PI) values was determined to be statistically significant ( p < 0.05). The preoperative PI values had no significant effect on ACI, but in cases with high preoperative PI values, a tendency to high anteversion values was determined. The mean inclination values were found to be 40.2° ± 11.0° in the low PI group, 41.7° ± 7.4° in the normal PI group, and 44.1° ± 8.3° in the high PI group. As no increase in inclination values was observed with an increase in PI values, no statistical correlation was determined ( p = 0.343). Average of anteversion values in the low PI group was 9.2° ± 13.7°, in the normal PI group 19.3° ± 10.5°, and in the high PI group 21.1° ± 12.5°. The difference between the groups was statistically significant ( p = 0.001). Conclusion: Evaluating the results of this study, it can be concluded that varying PI values do affect the acetabular cup anterversion in THA. So, preoperative assessment of PI values is important in preventing postoperative acetabular cup malposition.

Effect of ethyl alcohol on motor function in canine stomach

1992 ◽  
Vol 262 (2) ◽  
pp. G223-G230
Author(s):  
L. C. Knight ◽  
A. H. Maurer ◽  
R. Wikander ◽  
B. Krevsky ◽  
L. S. Malmud ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Solid Food ◽  
Blood Levels ◽  
Lag Phase ◽  
Dependent Manner ◽  
Solid Meal ◽  
The Mean ◽  
High Doses ◽  
Mean Time ◽  
Dose Dependent

The aim of this study was to elucidate the effects of ethanol on gastric emptying and the trituration of solid food. With the use of a noninvasive physiological imaging technique, gastric processing of a radiolabeled solid meal was evaluated in unanesthetized dogs which ingested 6-8% ethanol solutions or received intravenous alcohol before the meal. Oral alcohol (resulting in blood levels up to 174 mg/dl) decreased the amplitude of antral contractions or completely abolished them. Alcohol did not significantly affect the fundamental frequency of contractions except at high doses, at which contractions were abolished. Alcohol lengthened the mean time to 50% of gastric emptying in a dose-dependent manner, from 132 +/- 3 min without alcohol to 160 +/- 10 min with oral alcohol at blood levels of 80-120 mg/dl (P less than 0.05). This was manifested by a lengthening of the lag phase, but there was no effect on the terminal slope of emptying (emptying rate) of the processed meal. At equal blood levels up to 120 mg/dl, orally administered alcohol had a more pronounced effect than intravenous alcohol. These data suggest that even low doses of dilute alcohol affect the ability of the antrum to process solid food and thereby contribute to impairment of gastric emptying.

scholarly journals Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study

2014 ◽  
pp. 107 ◽  
Author(s):  
Jose Aguilar-Nascimento ◽  
Ana Dias ◽  
Diana Dock-Nascimento ◽  
Maria Correia ◽  
Antonio Campos ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Preoperative Fasting ◽  
Fasting Time

scholarly journals Say what? Patients have poor immediate memory of major risks of interscalene block disclosed during the informed consent discussion

2019 ◽  
Vol 44 (11) ◽  
pp. 981-985
Author(s):  
Johnny Wei Bai ◽  
Faraj W Abdallah ◽  
Melanie Cohn ◽  
Stephanie Ladowski ◽  
Poorna Madhusudan ◽  
...  
Keyword(s):  
Informed Consent ◽  
Multivariable Analysis ◽  
Preoperative Assessment ◽  
Interscalene Block ◽  
Immediate Memory ◽  
Peripheral Nerve Blockade ◽  
Arthroscopic Shoulder Surgery ◽  
Life Threatening ◽  
The Mean

BackgroundPoor memory of disclosed risks can undermine informed consent and create medicolegal challenges. The extent to which patients remember the risks of peripheral nerve blockade following the informed consent discussion is unknown. This prospective cohort study evaluated patients’ immediate memory of risks related to interscalene block (ISB) that were disclosed during the preoperative informed consent discussion.MethodsUsing a standardized script, patients scheduled for arthroscopic shoulder surgery were informed of the risks of ISB by an anesthesiologist in the preoperative assessment clinic. Immediately thereafter, consenting participants were asked to identify the risks of ISB from a printed list of nine true risks (four major and five minor) and nine ‘distractor’ items, which were unrelated adverse events and not disclosed. The primary outcome was the proportion of participants who remembered all four true major risks including long-term nerve damage, seizure, life-threatening event, and damage to the covering of the lung.ResultsAmong 125 participants, only 26 (21%) remembered all four major risks of ISB. The mean number of major risks remembered was 2±1 out of 4. Fifteen (12%) participants remembered all nine true risks. The mean number of true risks remembered was 6±2 out of 9. Multivariable analysis revealed that participants’ self-rated assessment of their memory was not associated with actual recall.ConclusionPatients have poor immediate memory of the major risks related to ISB disclosed during the informed consent discussion. Under the present study conditions, the validity of the informed consent process for patients undergoing ISB may be undermined.

scholarly journals What are the maternal risks and pregnancy outcomes after kidney transplantation?

2018 ◽  
Vol 6 (4) ◽  
pp. 111
Author(s):  
Amera Bekhatro Awad Allah Rashed ◽  
Mohamed Magdy Sharaf
Keyword(s):  
Kidney Transplantation ◽  
Pregnancy Outcomes ◽  
Pregnancy Induced Hypertension ◽  
Induced Hypertension ◽  
Assessment Sheet ◽  
Maternal Risks ◽  
The Mean ◽  
Risks Assessment ◽  
Normal Women ◽  
Kidney Functions

Background: Pregnancy after kidney transplantation should be considered as a major concern. Women with transplanted kidney were able to conceive for more than 50 years. Little studies are available highlighting the effects of transplantation on fetal and neonatal health.Purpose: This study was conducted with the purpose of identifying the maternal risks and pregnancy outcomes after kidney transplantation.Methods: Research design: A descriptive (non-experimental) design was used in conducting this study. Tools: Three tools were used during the course of this study, the interviewing questionnaire sheet, maternal risks assessment sheet and pregnancy outcomes sheet.Results: Regarding the maternal risks, there was a significant increase in mean serum creatinine, decrease in estimated glomerular filtration rate, increase in proteinuria, reported abortion rate was 16.3%, pregnancy induced hypertension rate was 20.9%; Among acquired infections, primary herpes simplex was very common with a rate of 18.6% while urinary tract infection rate was 39.5%. Among pregnancy outcomes, the mean gestational age was 35.4 ± 3, mean birth weight was 2,107.8 ± 567.7 and 74.4% of women delivered by C.s. 30.2% of delivered infants experienced incubator admission.Conclusions: The current findings succeeded in answering both study questions.Recommendation: Pregnant women with kidney transplantation should be followed-up more frequent than normal women for early detection of any risks and for obtaining favorable pregnancy outcomes. Women should be monitored frequently for kidney functions, early signs of pregnancy induced hypertension, acquired infections and other maternal risks reported by this study.

Attempt to shorten preoperative fasting time in Japan

2010 ◽  
Vol 27 ◽  
pp. 22
Author(s):  
K. Tanaka ◽  
N. Kurokouchi ◽  
K. Kawakami ◽  
N. Ando
Keyword(s):  
Preoperative Fasting ◽  
Fasting Time

Gastric Secretory and Mucosal Injury Response to Severe Head Trauma

Neurosurgery ◽  
1983 ◽  
Vol 12 (2) ◽  
pp. 175-179 ◽  
Author(s):  
Steven K. Gudeman ◽  
C. B. Wheeler ◽  
Douglas J. Miller ◽  
Gregg L. Halloran ◽  
Donald P. Becker
Keyword(s):  
Acid Output ◽  
Titratable Acidity ◽  
Mucosal Injury ◽  
Mean Value ◽  
Injury Response ◽  
Gastrointestinal Complications ◽  
Mucosal Erosion ◽  
The Mean ◽  
Level Of Significance ◽  
Injured Patients

Abstract The problem of gastric secretory and mucosal injury response was evaluated in 19 patients who had suffered a severe head injury. Fifteen of 19 patients had some evidence of gastrointestinal hemorrhage. In 7 cases, this was marked. The mean volume of gastric secretions ranged from 36.4 ml/hour on Day 1 to 47.6 ml/hour on Day 6. The mean value of titratable acidity ranged from 3.4 meq/hour on Day 1 to 3.9 meq/hour on Day 6. Possible risk factors were analyzed as a means of predicting specific subgroups of severely injured patients who would be more prone to have gastrointestinal complications. During the first 6 days after injury, there was no significant association (correlation coefficient not significant at the 0.05 level of significance) of the presence of an intracranial mass lesion, elevated intracranial pressure, brain stem dysfunction or prior episodes of hypotension or hypoxia, sepsis, shock, or the requirement for pressor agents with elevated gastric acid output, mucosal erosion, or hemorrhage. Because no specific risk factor or factors could be identified, all severely braininjured patients should be on some form of therapy for the prevention of gastrointestinal complications.

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