Long Pre Operative Fasting : An Standard Of Care For Patients Undergoing Elective Procedures

Long Pre Operative Fasting : An Standard Of Care For Patients Undergoing Elective Procedures

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Nil per os (NPO-nothing by mouth) after midnight has long been the standard of care for patients undergoing elective procedures. The American Society of Anesthesiologists (ASA) first recommended liberalization of NPO after midnight in 1999 and updated to the current guidelines (8 hours prior solid food, 6 hours prior a light meal of toast and clear liquids and 2 hours prior for clear liquids) in 2011. Liberal preoperative fasting has been implemented in most countries, however current studies reveal healthy adults are fasting from solid food on average of 14.5 hours, liquids 13 hours and clear liquids 12.5 hours before scheduled elective procedures (Kulshrestha, Mathews, Kapadia, & Sanwatsarkar, 2013). This prolonged fasting is not only uncomfortable for the patient; it is a leading cause of patient dissatisfaction. Prolonged fasting may also be associated with dehydration, hypoglycemia, and electrolyte imbalance and plays a role in post-op stress reactions by increasing insulin resistance and protein catabolism. How can compliance with current ASA guidelines be achieved in order to prevent unnecessary long pre-operative fasting?
Pre-operative fasting guidelines can be found as early as 1883 when Joseph Lister wrote, “while it is desirable that there should be no solid matter in the stomach when chloroform is administered, it will be found very salutary to give a cup of tea or beef-tea about two hours previously” (Kulshrestha et al, 2013).
It is well documented that general anesthesia attenuates the laryngeal reflexes and increases the risk of pulmonary aspiration (Ljungqvist, & Soreide, 2003). Pulmonary aspiration will lead to bronchoconstriction and inflammation that ranges in severity from coughing and wheezing to s...


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...f the clinicians with adhering to the guidelines; the concerns should be addressed with evidenced based studies.
Patients, and their families, will need to be educated on the current ASA guidelines for pre-operative fasting, the rational for the guidelines and insure they understand the postoperative benefits of the current guidelines.
Surveys of health care providers should be completed three months after implementation of ASA fasting standards to assess adherence with guidelines. A random survey of patients undergoing elective procedures should be completed within three months to assess their experience and understanding of NPO fasting times. There will need to be ongoing audits and assessment of pre-procedure education materials and information to patient and families. Data will need to be collected measuring fasting times and any associated complications.

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