Audit on Preoperative Fasting of Elective Surgical Patients in an African Academic Medical Center

Abstract

Background Preoperative fasting is a requisite before anesthesia. The main reason for preoperative fasting is to reduce gastric volume and acidity and thus decrease the risk of pulmonary aspiration. However, preoperative fasting is usually prolonged beyond the recommended time for various reasons. Despite the many adverse effects of prolonged fasting, patients sometimes fasted for a prolonged time when surgery was delayed for different reasons at the University of Gondar Hospital. The aim of this study was to assess the duration of preoperative fasting for elective surgery.MethodsA cross-sectional study was conducted from March 10 to April 10, 2013. Patients were interviewed 24 h after surgery. All 43 patients who were under anesthesia while operated on during the study period were included.Result Of the 43 patients included in the study, 35 were adults and 8 were children. The minimum, maximum, and mean fasting hours for food were 5, 96, and 19.60, respectively, and more than 50 % of the patients fasted from food twice as long as recommended. The minimum, maximum, and mean fasting hours for fluid were 5, 19, and 12.72, respectively. More than 95 % of the patients fasted from fluid longer than recommended.ConclusionMost patients fasted from both food (92 %) and fluid (95 %) longer than the fasting time recommended by the AAGBI, ASA, RCOA, and RCN fasting guidelines. Anesthetists, surgeons, and nurses need to revise operation lists every day in the operating theatres and resuscitate the patients when surgery is delayed for various reasons. A preoperative fasting guideline should be developed and implemented in the University of Gondar Hospital.

Correlation between duration of preoperative fasting and emergence delirium in pediatric patients undergoing ophthalmic examination under anesthesia: A prospective observational study

“…Furthermore, although sedative premedications were consistently effective in reducing preoperative anxiety, effects of them on the postoperative behavioral alteration is debatable. 11,12 Although no previous study evaluated interaction between preoperative fasting and ED in this setting, Xar a et al 13 in 2013 reported that prolonged preoperative fasting is a risk factor for postoperative emergence along with postoperative pain and major surgery and Chauvin et al 6 also reported that thirst might be a reason for unsettling behavior in children in the postoperative period. A number of studies 12,14 have reported a significantly longer duration of fasting than recommended by the various society guidelines.…”

Preoperative fasting times: Prescribed and actual fasting times at Universitas Hospital Annex, Bloemfontein, South Africa

“…The degree of postoperative hunger and thirst in these patients did not correlate with the duration of fasting, as 51.2% of patients who fasted from fluids for ≥9 hours did not experience any thirst postoperatively. [10] Furthermore, the methodology of Cestonaro et al, [11] who conducted a retrospective study in a public university hospital in the south of Brazil, was very similar to ours. Their results showed that the median period of preoperative fasting from solid food was 16 hours and 30 minutes (5 hours and 30 minutes -56 hours and 55 minutes) and from fluids 15 hours and 45 minutes (2 hours and 30 minutes -56 hours and 55 minutes).…”

“…Gebremedhn and Nagaratnam [10] conducted a cross-sectional study, where 43 patients h00 17h00 18h00 19h00 20h00 21h00 22h00 23h00 00h00 01h00 02h00 03h00 04h00 05h00 06h00 07h00 08h00 09h00 RESEARCH underwent elective surgery. Their methods and results were similar to ours.…”

“…The majority of patients (58%) fasted from solid food for >12 (5 -96) hours, although there were no patients in our study who fasted from solid food >20 hours. Similarly, patients fasted too long from clear fluids in the Gebremedhn and Nagaratnam study, [10] with most patients (48.8%) fasting for >12 hours. The degree of postoperative hunger and thirst in these patients did not correlate with the duration of fasting, as 51.2% of patients who fasted from fluids for ≥9 hours did not experience any thirst postoperatively.…”

An Audit Assessment of Preoperative Fasting for Elective Surgeries

“…[7] In a study done by Gebremendhn EG et al, the mean duration was even higher, being 19.6 hours. [8] Although, the guidelines recommend pre-operative clear fluid intake 2 hours prior to the surgery, the knowledge regarding the definition of clean fluids was lacking among the study participants. Studies have shown discrepancies in the instructions given by anaesthetists and the implementation of this instruction by the nurses in the wards.…”