fasting before surgery - unneccessary?

stbernardclub · Dec 23, 2004

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.

meandragonbrett · Dec 23, 2004

While yes, anesthesia has changed, there is still a risk of vomiting upon intubation and a risk for aspiration pneumonia.

donmurray · Dec 23, 2004

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.

TiffyRN, BSN, PhD · Dec 23, 2004

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.

totallytheresa · Dec 23, 2004

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!!!

lsyorke, RN · Dec 24, 2004

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.

heartICU · Dec 24, 2004

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.

Fun2, BSN, RN · Dec 24, 2004

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)

UM Review RN, ASN, RN · Dec 24, 2004

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.

shodobe · Dec 24, 2004

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

Jamesdotter · Dec 25, 2004

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.