All patients who present for surgery under general, regional or monitored anaesthesia are given preoperative fasting instructions. At our institution, adult patients scheduled for surgery before 1:00 pm are required to fast from 12:00 midnight the preceding night, while patients whose surgeries are scheduled to start after 1:00 pm are allowed a light breakfast before 6:00 am. Paediatric patients are required to fast from solid food and milk at least 6 hours before surgery, and from clear fluids at least 2 hours before surgery. Infants are allowed milk up to 4 hours before surgery. In the past, all patients scheduled for elective surgery were admitted to the hospital at least a day before surgery. Fasting rules were strictly enforced by nurses in the wards, and noncompliance was rarely encountered. In recent times, however, patients are increasingly admitted on the day of surgery due to a shortage of hospital beds and economic considerations. As a result, it is our anecdotal observation that there has been an increase in the number of patients who do not comply with fasting instructions. This is despite the fact that all patients are informed of the need to fast before surgery, both verbally and in writing. We therefore embarked on a survey of our patients, who were admitted on the day of surgery, on their knowledge on preoperative fasting, as well as their perception of and attitudes toward preoperative fasting. We aimed to estimate the extent of noncompliance with preoperative fasting instructions in our local patient population and to elicit the reasons for any noncompliance observed.
We have found the prevalence of cognitive impairment amongst Singapore's elderly to be higher than previously reported. These findings imply that current resources may be inadequate for the effective care and management of the cognitively-impaired elderly in our aging community.
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