fasting before surgery - unneccessary?

  1. this is kind of old, but i just came across it. what do you think? do any canadian nurses have experience with the lemonade?

    http://www.drgreene.com

    fasting before surgery
    one of the unpleasant aspects of my son's operation was not allowing him to eat or drink after midnight the night before surgery. he was too young to understand - especially when the surgery start time was delayed. the practice of fasting was begun to prevent vomiting with the anesthesia. while surgery and anesthesia have both changed since, this practice hasn't. a study presented at the 21st annual conference of the european society of parenteral and enteral nutrition (espen) in 1999, suggests that not only are there no increased complications from feeding before surgery, but that those who do get a carbohydrate beverage feel better and recover more quickly! this is consistent with experience in canada, where some physicians have been giving lemonade before surgery for ten years. another benefit of nutrition! wouldn't it be wonderful if further research confirms these findings, and the traditional "nothing by mouth" becomes a thing of the past!

    alan greene md faap

    september 13, 1999
    •  
  2. 18 Comments

  3. by   stbernardclub
    Thats interesting, however for myself I was sickened by the use of morphine and other pain meds post surgery. If I were to have eaten before surgery, I would think the N/V may have been worse.
  4. by   meandragonbrett
    While yes, anesthesia has changed, there is still a risk of vomiting upon intubation and a risk for aspiration pneumonia.
  5. by   donmurray
    The object of fasting is to minimise the residual gastric content, which in turn, minimises but does not remove the aspiration risk. Different substances are absorbed at different rates. As I recall, in Oxford UK, cows milk, or a light meal such as toast, could be taken up to 6 hours before surgery, and clear fluids 2 hours, with no increased risk.
  6. by   TiffyRN
    I know the thought is changing some, at least where I last had surgery. I had a couple of minor surgical procedures but under general endotracheal anesthesia in the last few years. I had a pre-op call from the anesthesia staff. They told me the anesthsiologist in charge of my care had newer thoughts about eating & drinking. I was told no solids after 2am and no liquids after 4am for a 7:30am procedure. Of course I wasn't up at 2am looking for a snack but I did get up in the middle of the night and have a sip of water. Anyway, I hope my anesthesiologist wasn't a whacko and actually had some research behind his practice.
  7. by   totallytheresa
    I had surgery this year, and the anesthesiologist told me (right before he put me under) that it would've been ok to eat lightly, but most people won't abide by that, since everyone's opinion of what is light is different! Better safe than sorry. But since my surgery was at 1 in the afternoon, but NPO since midnight, I would've LOVED a cup of coffee!!!
  8. by   lsyorke
    When my son had multiple surgeries(age 1-3) in the late 80's the anesthesiologists rule was NPO for 4 hours before. Never had a problem. I've been a nurse for 20 years and can honestly say that I've never heard of a patient vomiting in the OR during intubation.
  9. by   heartICU
    Quote from lsyorke
    When my son had multiple surgeries(age 1-3) in the late 80's the anesthesiologists rule was NPO for 4 hours before. Never had a problem. I've been a nurse for 20 years and can honestly say that I've never heard of a patient vomiting in the OR during intubation.
    Pediatric NPO rules are a little 'smaller' than adults. Kids, (especially younger ones) can't go as long without eating, so the amount of time required to fast is less.

    When a patient vomits during intubation, it may not always be visible. The gastric contents may simply come up the esophagus and go straight back down into the lungs. However, the reason it doesn't happen as often is because the anesthesia providers take precautions against it, including rapid sequence inductions, etc.
    Last edit by heartICU on Dec 23, '04
  10. by   Fun2, RN, BSN
    I think I'd rather be NPO, or at least no solids, but ice chips allowed. I can't imagine having solids in my stomach to have to vomit after surgery.. ewwwwwe stomach acids and/or blood is bad enough (facial surgeries)
  11. by   UM Review RN
    When I had a recent surgery scheduled for 7 am, I had about 10 ounces of water at about 3 am, because if I didn't, they'd never be able to get an IV in me.

    The only problem turned out to be that they said that the water actually diluted my urine specimen for the pregnancy test pre-op, so they had to draw blood for it instead.

    Since I had to have the IV, and I was absolutely certain that I wasn't prego, I'd do it again in a heartbeat.

    I didn't eat anything because years ago, I came out of anesthesia feeling kinda queasy and had some dry heaves when I sat up. Thank goodness I was in ICU and the nurse was right there with the Phenergan.
  12. by   shodobe
    Quote from lsyorke
    When my son had multiple surgeries(age 1-3) in the late 80's the anesthesiologists rule was NPO for 4 hours before. Never had a problem. I've been a nurse for 20 years and can honestly say that I've never heard of a patient vomiting in the OR during intubation.
    Obviously you don't work in the OR. I do and I can tell you there have been many a patient that vomits during intubation during my years, 28 to be precise. This is usually due to the fact they have not been NPO the required time or it is an emergency and NPO status means nothing. I can always tell when a patient "cheats" on their NPO status and it isn't a pretty sight. We have new rules we go by and children are given more lienency(?) when it comes to NPO status. I am still from the old school and adults should always be at least 6-8 hours NPO before any abdominal procedure and at least 4 hours for anything else. I have some anesthesiologists that go by their own rules, some that strictly adhere to the 8 hour rule. I personally don't like patients to have anything even before a local procedure, but that is just me. I think if you poll the OR nurses you will find that they all have had some experience with patients vomiting during intubation, if not then I want to go and work there because it is obviously a perfect place. Mike
  13. by   Jamesdotter
    We once had a pre-op c/section patient eat sausage(!) before the scheduled procedure. The surgery was put off for several hours, but she still had one of the most painful cases of postop ilius we'd seen in awhile.
  14. by   obeyacts2
    Well, the NPO rule of 6-8hrs beforehand may be inconvenient, or uncomfortable for some, I would rather be uncomfortable than risk aspiration Pneumonia. Aspiration pneumonia is a common precursor to ARDS. This is how I got ARDS years ago. I wouldnt wish ARDS on my worst enemy. I still deal with some of the aftereffects years later.


    Laura

close