The evidence base behind modern fasting guidelines

Stuart, Pauline

doi:10.1016/j.bpa.2006.03.001

Cited by 47 publications

(39 citation statements)

References 27 publications

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“…Such an approach has been proven to have no adverse effect on gastric volume and pH preoperatively compared with water or fasting from midnight. [8,12] It has the positive effect of decreasing insulin resistance [12,13] and increasing recovery [14] of patients postoperatively. As most operations start after 07h00, this drink of water or apple juice falls within the international fasting guideline of 2 hours for clear fluids.…”

Section: Resultsmentioning

confidence: 99%

“…However, the recent literature [1,3,8] demonstrated that prolonged fasting could be detrimental to a patient's welfare and wound healing. Therefore, the Department of Anaesthesiology changed its practice regarding preoperative fasting times more than a decade ago and has since taught medical students and anaesthesiology registrars to use the fasting guidelines of 6 hours for solid food and 2 hours for clear fluids.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Background. Guidelines recommend a preoperative fasting period of 6 hours for solid food and 2 hours for clear fluids. Because of fixed meal times and imprecise operation starting times, patients often fast for an extended period of time.Objective. To investigate the prescribed preoperative fasting times, and the actual duration of fasting, compared with the internationally accepted fasting times for solid food and clear fluids.Methods. Patients (N=105) aged 14 -60 years, who were scheduled for elective surgery in the morning session (list starting time 07h00), were included in this prospective study. On arrival in theatre, all patients were asked when they last ate and drank. Anaesthetic records were used to determine the prescribed fasting times and operation starting times. Results. For solids, patients were most frequently prescribed to start fasting from 22h00 to 00h00 (53.3% and 39.1%, respectively). No patient fasted <8 hours. The median duration of fasting was 14 hours and 45 minutes (range 9 hours and 45 minutes -19 hours and 5 minutes). For fluids, patients were most frequently prescribed to start fasting from 05h00 (46.7%), 00h00 (27.6%) and 22h00 (7.6%). In practice, no patient ingested fluids after 22h30 or <9 hours preoperatively. The median fasting time for oral fluids was 13 hours and 25 minutes (range 9 hours and 37 minutes -19 hours and 5 minutes). Conclusion. Most patients started fasting too early preoperatively, consequently withholding food and oral fluids for longer than recommended. An increased awareness regarding complications of unnecessarily long fasting times, and interventions to correct this problem, is required.S Afr Med J 2017;107(10):910-914.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…The risk of aspiration during anesthesia was feared and thus the practice of fasting was imposed, without proper evidence, since the night before the operation. In the 1980s and 1990s this requirement was challenged in randomized prospective studies that have shown that the adoption of uniform periods of fasting for two / three hours after ingestion of clear liquids or drinks with carbohydrates was safe 15 . In addition, preoperative fasting, besides quite uncomfortable and unnecessary, can be harmful by enhancing or perpetuating the organic response to trauma 14 .…”

Section: Results Results Results Resultsmentioning

confidence: 99%

Resultados clínicos antes e após a implantação do protocolo ACERTO

Costa¹,

Santos²,

Aguilar-Nascimento

2013

Rev. Col. Bras. Cir.

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OBJETIVO: Comparar os resultados clínicos pós-operatórios de pacientes submetidos à cirurgia oncológica no Hospital de Câncer de Mato Grosso antes e após a implantação do protocolo ACERTO. MÉTODOS: Foram prospectivamente observados 271 pacientes durante dois períodos: o primeiro, entre abril e maio de 2010 (n=101) formado por pacientes submetidos a condutas convencionais (Fase 1) e o segundo, entre setembro a outubro de 2010 (n=171), formado por pacientes submetidos a um novo protocolo de condutas peri-operatórias estabelecidas pelo projeto ACERTO (Fase 2). As variáveis observadas foram: tempo de jejum pré-operatório, reintrodução da dieta no período pós-operatório, volume de hidratação e tempo de internação. RESULTADOS: Na comparação entre os dois períodos, na Fase 2 houve uma queda de aproximadamente 50% do tempo de jejum pré-operatório (14,7 [4-48] horas vs 7,2 [1-48] horas, p<0,001), houve redução de aproximadamente 35% do volume de fluidos intravenosos no pós-operatório imediato (p<0,001), de 47% no 1º PO (p<0,001) e de 28% no 2º PO (p=0,04), sendo a redução global de 23% (p<0,001). Não houve diferença no tempo de internação pós-operatória entre as duas fases (3,9 [0-51] vs. 3,2 [0-15] dias; p=0.52). Entretanto, nos pacientes cujo tempo de jejum pré-operatório foi de até 5 horas houve redução de um dia de internação (3.8 [0-51] vs 2.5 [0-15] dias, p=0,03). CONCLUSÃO: A adoção das medidas do projeto ACERTO é factível e segura em doentes oncológicos. Após a implantação do protocolo ACERTO reduziu-se o volume de fluidos intravenosos e quando o jejum pré-operatório foi reduzido o tempo de internação foi menor.

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“…Bu uygulamanın amacı midenin boşalmasını sağlayarak anestezi sırasında mide içeriğinin akciğerlere kaçma riskini azaltmaktır (Baril ve Portman 2007). Genel anestezikler akciğer-leri koruma fonksiyonu olan refl eksleri azaltarak mide içeriğinin aspire edilmesine ve böylece yaşamı tehdit eden önemli solunum problemlerinin gelişmesine neden olabilmektedir (Crenshaw ve Winslow 2002;Stuart 2006). Ameliyat öncesi besin ve sıvı kısıtlamasının taşıdığı önem nedeniyle, hastaların ameliyat öncesin-de uygun şekilde aç kalmalarını sağlamak hemşirele-rin temel sorumluluklarından birisidir.…”

Section: Introductionunclassified