Verkürzte präoperative Nüchternheit

Jp, Breuer; Bosse, G.; Prochnow, Lisa; Seifert, Sven; Langelotz, Corinna; Wassilew, Georgi I.; François-Kettner, Hedwig; Polze, N.; Spies, Claudia

doi:10.1007/s00101-010-1736-4

Cited by 18 publications

(13 citation statements)

References 24 publications

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“…In addition, our data clearly showed that although the period of preoperative fasting is usually greater than that prescribed, fasting is shorter in patients receiving the new protocol of 2 hours fasting for carbohydrate-enriched drinks. Similar to our findings, a survey in Germany showed a mean fasting time of 15 hours for solids in 784 participating patients 8. As far as we know, these findings are uncommonly reported.…”

Section: Discussionsupporting

confidence: 91%

Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study

Aguilar-Nascimento¹,

Conde²,

Dock-Nascimento³

et al. 2014

TCRM

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BackgroundProlonged fasting increases organic response to trauma. This multicenter study investigated the gap between the prescribed and the actual preoperative fasting times in Brazilian hospitals and factors associated with this gap.MethodsPatients (18–90-years-old) who underwent elective operations between August 2011 and September 2012 were included in the study. The actual and prescribed times for fasting were collected and correlated with sex, age, surgical disease (malignancies or benign disease), operation type, American Society of Anesthesiologists score, type of hospital (public or private), and nutritional status.ResultsA total of 3,715 patients (58.1% females) with a median age of 49 (18–94) years from 16 Brazilian hospitals entered the study. The median (range) preoperative fasting time was 12 (2–216) hours, and fasting time was longer (P<0.001) in hospitals using a traditional fasting protocol (13 [6–216] hours) than in others that had adopted new guidelines (8 [2–48] hours). Almost 80% (n=2,962) of the patients were operated on after 8 or more hours of fasting and 46.2% (n=1,718) after more than 12 hours. Prolonged fasting was not associated with physical score, age, sex, type of surgery, or type of hospital. Patients operated on due to a benign disease had an extended duration of preoperative fasting.ConclusionActual preoperative fasting time is significantly longer than prescribed fasting time in Brazilian hospitals. Most of these hospitals still adopt traditional rather than modern fasting guidelines. All patients are at risk of long periods of fasting, especially those in hospitals that follow traditional practices.

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Section: Discussionsupporting

confidence: 91%

Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study

Aguilar-Nascimento¹,

Conde²,

Dock-Nascimento³

et al. 2014

TCRM

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“…Breuer et al . [41] also found mean fluid fast times of 10 hours and mean food fast times of 15 hours. Given that current practice appeared to be so far away from the guideline recommendations, it seemed reasonable to expect the more intensive interventions would have a substantial impact on fasting time and would not otherwise be clinically worthwhile, hence a large effect size was used in the sample size calculation.…”

Section: Methodsmentioning

confidence: 98%

A pragmatic cluster randomised trial evaluating three implementation interventions

et al. 2012

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BackgroundImplementation research is concerned with bridging the gap between evidence and practice through the study of methods to promote the uptake of research into routine practice. Good quality evidence has been summarised into guideline recommendations to show that peri-operative fasting times could be considerably shorter than patients currently experience. The objective of this trial was to evaluate the effectiveness of three strategies for the implementation of recommendations about peri-operative fasting.MethodsA pragmatic cluster randomised trial underpinned by the PARIHS framework was conducted during 2006 to 2009 with a national sample of UK hospitals using time series with mixed methods process evaluation and cost analysis. Hospitals were randomised to one of three interventions: standard dissemination (SD) of a guideline package, SD plus a web-based resource championed by an opinion leader, and SD plus plan-do-study-act (PDSA). The primary outcome was duration of fluid fast prior to induction of anaesthesia. Secondary outcomes included duration of food fast, patients’ experiences, and stakeholders’ experiences of implementation, including influences. ANOVA was used to test differences over time and interventions.ResultsNineteen acute NHS hospitals participated. Across timepoints, 3,505 duration of fasting observations were recorded. No significant effect of the interventions was observed for either fluid or food fasting times. The effect size was 0.33 for the web-based intervention compared to SD alone for the change in fluid fasting and was 0.12 for PDSA compared to SD alone. The process evaluation showed different types of impact, including changes to practices, policies, and attitudes. A rich picture of the implementation challenges emerged, including inter-professional tensions and a lack of clarity for decision-making authority and responsibility.ConclusionsThis was a large, complex study and one of the first national randomised controlled trials conducted within acute care in implementation research. The evidence base for fasting practice was accepted by those participating in this study and the messages from it simple; however, implementation and practical challenges influenced the interventions’ impact. A set of conditions for implementation emerges from the findings of this study, which are presented as theoretically transferable propositions that have international relevance.Trial registrationISRCTN18046709 - Peri-operative Implementation Study Evaluation (POISE).

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“…The gold standard for the specific POF duration for a patient fed on liquid or solid diet has been prescribed and adopted globally [6]. The guidelines are flexible, and they prescribe safe and friendlier package to the patient, with no significant complications reported in their implementation [7]. The prescribed POF guideline is a departure from traditional practice where patients were fasted from midnight to the following day's surgery regardless of the patient's condition, work load, theatre schedules, emergencies, and other logistical challenges.…”

Section: Introductionmentioning

confidence: 99%

“…The instructions should be clear including the objective of POF, duration, and the expectations as well as the consequences of nonadherence. Therefore, the clinician should be conversant with the guidelines and communicate and deliver clear instructions to the patients [7]. Lack of knowledge, rigidity, and/or poor strategies for disseminating fasting guidelines among the clinical team impede patient understanding and fasting compliance [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Fasting among Adult Patients for Elective Surgery in a Kenyan Referral Hospital

Njoroge

Kivuti-Bitok

Kimani

2017

International Scholarly Research Notices

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Background. Preoperative fasting (POF) is physiologically and precautionary important during anesthesia and surgery. POF from midnight has been practiced despite the recommended shorter practice. Objective. Assessing preoperative fasting among adult patients scheduled for elective surgery at Kenyatta National Hospital (KNH). Methods. A descriptive cross-sectional study involving 65 surgical patients. A questionnaire of mixed questions on demographics, reasons, source of instructions, opinion on instructions, time, premedication practices, outcome, and complains on NPO was used. Analysis was quantitatively done with SPSS v. 22. Ethical approval was obtained from KNH-UoN ERC. Results. Of the respondents 93.8% lacked knowledge on the correct reasons for POF and felt that the instructions were unclear and less important <50%. POF instructions were administered by nurses 80%, anesthetists 15%, and surgeons 5%. Most of respondents (73.8%) fasted > 15 hours. The POF outcomes were rated moderately challenging as follows: prolonged wait for surgery 44.6%, thirst 43.1%, hunger 36.9%, and anxiety 29.2%. Conclusion. Nurses are critical in providing POF instructions and care, and patient knowledge level is a mirror reflection of the quality of interventions. This underscores the need to build capacity for nurses and strengthen the health system to offer individualized preoperative interventions as well as monitoring and clinical auditing of fasting practices.

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Verkürzte präoperative Nüchternheit

Cited by 18 publications

References 24 publications

Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study

Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study

A pragmatic cluster randomised trial evaluating three implementation interventions

Preoperative Fasting among Adult Patients for Elective Surgery in a Kenyan Referral Hospital

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