Chewing Gum in the Preoperative Fasting Period: An Analysis of De-Identified Incidents Reported to Webairs

Abstract

The role of preoperative fasting is well established in current anaesthetic practice with different guidelines for clear fluids and food. However, chewing gum may not be categorised as either food or drink by some patients, and may not always be specified in instructions given to patients about preoperative fasting. The aim of this paper was to review anaesthesia incidents involving gum chewing reported to webAIRS to obtain information on the risks, if any, of gum chewing during the preoperative fasting period. There were nine incidents involving chewing gum reported between late 2009 and early 2015. There were no adverse outcomes from the nine incidents other than postponement of surgery in three cases and cancellation in one. In particular, there were no reports of aspiration or airway obstruction. Nevertheless, there were five cases in which the gum was not detected preoperatively and was found in the patient's mouth either intraoperatively or postoperatively. These cases of undetected gum occurred despite patient and staff compliance with their current preoperative checklists. While the risk of increased gastric secretions related to chewing gum preoperatively are not known, the potential for airway obstruction if the gum is not detected and removed preoperatively is very real. We recommend that patients should be specifically advised to avoid gum chewing once fasting from clear fluids is commenced, and that a specific question regarding the presence of chewing gum should be added to all preoperative checklists.

Assessing the effect of sugar-free chewing gum use on the residual gastric volume of patients fasting for gastroscopy: A randomised controlled trial

“…Some anaesthetists may draw the conclusion that a patient who has been chewing gum is inadequately fasted for sedation or general anaesthesia, and subsequently delay or cancel that patient who is otherwise fully prepared for their procedure. 2,3 The rationale for conducting this study was to provide evidence to practising anaesthetists to improve their ability to make clinical decisions about patient safety when faced with this problem. Our study detected an overall low incidence (7.1%) of fasting patients having a residual gastric volume >50 ml.…”

“…2 However, it is not known if chewing gum while fasting prior to elective surgery poses an increased risk of pulmonary aspiration if anaesthesia proceeds. 3 To compound this problem, there is no standard approach to the use of chewing gum in the fasting guidelines published by anaesthesia professional associations, including the Australian and New Zealand College of Anaesthetists (ANZCA), 4 European Society of Anaesthesiology (ESA), 5 Association of Anaesthetists of Great Britain and Ireland (AAGBI) 6 and American Society of Anesthesiologists (ASA). 7 This creates a situation where anaesthetists must use their own experiential judgement when deciding if a patient who has been chewing gum is adequately fasted for anaesthesia.…”

Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists

“…It may be important to ensure that patients spit out chewing gum before the administration of anaesthesia or sedation (LOE- Low). [ 141 ] Chewing gum in the postoperative period is not common practice in India. A Cochrane review and 1 other meta-analysis have found early return of bowel function with chewing gum in the postoperative period (LOE- Low).…”

Pre‐operative chewing gum, and carbohydrates – a reply

“…A recent paper demonstrated that over a 5.5‐year period, five cases were identified in which gum was not detected pre‐operatively and was later found in the patient's mouth intra‐operatively or postoperatively. The authors recommended that a specific question on checklists for chewing gum might therefore be required .…”