fasting before surgery - unneccessary?

[trent]

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

[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

[geekgolightly, BSN, RN]

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

How do you feel about the clear liquids 2 hours before sx?

[shodobe]

geekgolightly, I think it would depend on the procedure. To me liquids are liquids, no matter if you can see through it or not. The biggest problem I see is surgeons will put their patients NPO after midnight for a scheduled 8 or 9 am case and the procedure will get delayed till late in the afternoon. Sometimes patients will go NPO from 8 to 16 hours! You can not sometimes judge when the surgeon will arrive. It is frustrating to say the least and the floors are constantly calling you about when the patient is going to surgery, they are hungry! I think clear liquids in moderate amounts up to two hours before surgery would be OK in short, non-abominal procedures. Sometimes turning these into Locals for the benefit of the surgeon is no benefit for the patient. It is a hard call sometimes. Mike

[geekgolightly, BSN, RN]

geekgolightly, I think it would depend on the procedure. To me liquids are liquids, no matter if you can see through it or not. The biggest problem I see is surgeons will put their patients NPO after midnight for a scheduled 8 or 9 am case and the procedure will get delayed till late in the afternoon. Sometimes patients will go NPO from 8 to 16 hours! You can not sometimes judge when the surgeon will arrive. It is frustrating to say the least and the floors are constantly calling you about when the patient is going to surgery, they are hungry! I think clear liquids in moderate amounts up to two hours before surgery would be OK in short, non-abominal procedures. Sometimes turning these into Locals for the benefit of the surgeon is no benefit for the patient. It is a hard call sometimes. Mike

Thank you for the thoughful response.

[barefootlady, ADN, RN]

The best surgeon I ever knew demanded 8 hours of NPO if possible. His patients were always on the rebound quicker than others. He gave a vitamin IV after surgery and had the nurses on a 2 hour incentive spirometer orders, c, t, db, and leg lifts were routine on his patients too. I loved his demeanor. He was a true professional and I am sorry we lost him to another state due to malpractice insurance. He never had a case. But the cost was too high since he did high risk surgery.

[gwenith, BSN, RN]

I work ICU too an have seen far, far too many aspiration pneumonias - usually post resuscitation or BIBA after being found unconscious in pool of vomit. A severe aspiration with a low PH is a chemical burn - they are often fatal. Mortality is directly associated with the PH.

Every so often we get someone who starts coughing then gags and then vomits while intubated (we run at a lower sedation rate than the USA does I think). We are always aware of the potential for aspirate to "trickle" down around the cuff.

And then there is Mendelson's syndrome - passive regurgitation although Cricoid pressure is supposed to stop passive regurgitation during intubation. ME??? Rather be safe than sorry. Before I change practice I would like to see those research articles for myself.

[purplemania, BSN, RN]

what bothers me is that people adhere to "NPO after Midnight" when that was designed for procedures occuring between 0600-0800. Some people think midnight is a special hour for some reason, regardless of when the surgery is planned. In pedi's we try to keep babies NPO 4-6 hours before surgery or give clear liquids. Never had a problem with aspiration afterwards, so my thinking is that NPO is overdone and "after midnight" is WAY too rigid. When I complained (lightheartedly) to the GI doc about the colonoscopy prep being the hardest part of the procedure, he said "Oh, you didn't have to really take all those laxatives. You could have stayed on a clear liquid diet for 24 hrs" Well, NOW you tell me!