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 Conclusions Many anesthetists continue to follow outdated practices.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.

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.

scholarly journals Pulmonary Aspiration During Induction of General Anesthesia

2020 ◽  
Vol 67 (4) ◽  
pp. 214-218
Author(s):  
Reina Hayashi ◽  
Shigeru Maeda ◽  
Taninishi Hideki ◽  
Hitoshi Higuchi ◽  
Takuya Miyawaki
Keyword(s):  
General Anesthesia ◽  
Chest Radiograph ◽  
Lower Lobe ◽  
Pulmonary Aspiration ◽  
University Hospital ◽  
Clear Fluid ◽  
Incisive Canal ◽  
Anesthesia Providers ◽  
Patient Reported ◽  
Gastric Contents

Perioperative pulmonary aspiration of gastric contents can induce complications of varying severity, including aspiration pneumonitis or pneumonia, which may be lethal. A 34-year-old man with no significant medical history presented to Okayama University Hospital for extraction of the third molars and incisive canal cystectomy under general anesthesia. He experienced pulmonary aspiration of clear stomach fluid during mask ventilation after induction. After aspiration occurred, the patient was immediately intubated, and suctioning was performed through the endotracheal tube (ETT). An anteroposterior (AP) chest radiograph was obtained that demonstrated atelectasis in the left lower lobe, in addition to increased peak airway pressures being noted, although SpO2 remained at 96% to 99% at an FiO2 of 1.0. The decision was made to proceed, and the scheduled procedures were completed in approximately 2 hours. A repeat AP chest radiograph obtained at the end of the operation revealed improvement of the atelectasis, and no residual atelectasis was observed on the next day. Although the patient reported following standard preoperative fasting instructions (no fluids for 2 hours preoperatively), more than 50 mL of clear fluid remained in his stomach. Because vomiting can occur despite following NPO guidelines, the need for continued vigilance by anesthesia providers and proper timely management is reinforced.

Preoperative Fasting in the Pediatric Patient

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.

Perioperative fasting: A review

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.

Electronic Communication, Telehealth, and Social Media

2018 ◽  
Author(s):  
Muniya S. Khanna ◽  
Tommy Chou
Keyword(s):  
Social Media ◽  
Rural Communities ◽  
Unmet Need ◽  
Mental Healthcare ◽  
Evidence Base ◽  
Intervention Delivery ◽  
Safety Issues ◽  
Video Teleconferencing ◽  
Empirically Supported ◽  
Traditional Service

Explosive growth of communication technologies and increased ubiquity of Internet access in both urban and rural communities and particularly in youth have occurred. Coupled with concerns regarding limitations to traditional service provision models, researchers and practitioners are looking to affordable, acceptable technologies to expand the reach of evidence-based care and reduce barriers to intervention and unmet need in areas with few providers. This chapter describes the present literature on use of video teleconferencing, web-based programs, social media, and smartphone apps to enhance mental health intervention delivery, psychiatric assessment, and training and supervision. The strengths of the various delivery methods are discussed for providing empirically supported mental healthcare, focusing on implications related to science and practice with children and families. Outlined also are current limitations, risks, and challenges to technology-mediated services, including the significant gaps in the evidence base underlying these technologies and the legal, ethical, and safety issues that remain.

PULMONARY ASPIRATION OF GASTRIC CONTENTS IN OBSTETRIC PATIENTS

1967 ◽  
Vol 11 (2) ◽  
pp. 152???153
Author(s):  
P. W. MCCORMICK ◽  
R. G. HAY ◽  
R. W. GRIFFIN
Keyword(s):  
Pulmonary Aspiration ◽  
Gastric Contents

How to manage problems with bodily functions

2021 ◽  
pp. 141-156
Author(s):  
Andrew E. Budson ◽  
Maureen K. O’Connor
Keyword(s):  
Fluid Intake ◽  
Physical Therapist ◽  
Dry Skin ◽  
Medical Problems ◽  
Loved One ◽  
Solid Foods ◽  
Skin Cover ◽  
Swallowing Evaluation

Although dementia can disrupt many bodily functions, there are ways you can help your loved one and yourself. Determine the cause of any falls and work proactively to prevent future ones. If their walking is impaired, work with a physical therapist to improve it. To reduce incontinence, use a toileting schedule, decrease fluid intake before bed, and plan ahead when you go on outings. Make meals more enticing by increasing the flavor and spice of food. Use heavy silverware and mugs to dampen tremors. Improve swallowing and reduce choking by altering the consistency of solid foods and liquids and consider a swallowing evaluation. Reduce the difficulties inherent in activities requiring skilled or complicated movements to the extent possible. Lessen scratching and picking by treating medical problems and dry skin; cover the arms if needed.

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