Nil by mouth: A misleading statement

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.

Download Full-text

Preoperative Fasting Practices Across Three Anesthesia Societies: Survey of Practitioners

JMIR Perioperative Medicine ◽

10.2196/15905 ◽

2020 ◽

Vol 3 (1) ◽

pp. e15905 ◽

Cited By ~ 2

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.

Download Full-text

Preoperative Fasting in the Pediatric Patient

10.1093/med/9780190678333.003.0006 ◽

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.

Download Full-text

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

POCUS Journal ◽

10.24908/pocus.v1i2.13254 ◽

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.

Download Full-text

Preoperative Fasting in the Pediatric Patient

10.1093/med/9780199764495.003.0007 ◽

2013 ◽

Author(s):

Nancy S Hagerman ◽

Eric P Wittkugel

Keyword(s):

Pediatric Patient ◽

Pulmonary Aspiration ◽

Evidence Based ◽

Rare Occurrence ◽

Preoperative Fasting ◽

Prolonged Fasting ◽

Gastric Contents ◽

The Creation

Preoperative fasting guidelines are designed to minimize the risk of pulmonary aspiration of gastric contents. As pulmonary aspiration is a rare occurrence, however, 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.

Download Full-text

Perioperative fasting: A review

Journal of Perioperative Practice ◽

10.1177/1750458919877591 ◽

2019 ◽

Vol 30 (7-8) ◽

pp. 204-209

Author(s):

Mark Dorrance ◽

Michael Copp

Keyword(s):

Best Practice ◽

Perioperative Period ◽

Pulmonary Aspiration ◽

Surgical Patients ◽

Preoperative Fasting ◽

Healthcare Staff ◽

Gastric Contents ◽

Current Guidelines ◽

Future Practice ◽

Review Current

Preprocedural/preoperative fasting is a key part of preparing a patient for undergoing sedation or anaesthesia to minimise the risk of pulmonary aspiration of gastric contents. As part of caring for elective surgical patients it is important that healthcare staff in the perioperative environment have a good understanding of both the current guidelines and underpinning evidence so that they can effectively manage preoperative patients. This article looks to summarise the latest guidelines regarding perioperative fasting for adult and paediatric patients, the underlying evidence behind these guidelines and finally review current literature which will inform future practice. This article therefore looks to reinforce best practice, to ensure that the safety and comfort of patients in the perioperative period is optimised.

Download Full-text