Fasting in Elective Surgical Patients: Comparison Among the Time Prescribed, Performed and Recommended on Perioperative Care Protocols

Abstract

Background: Prolonged preoperative fasting may impair nutritional status of the patient and their recovery. In contrast, some studies show that fasting abbreviation can improve the response to trauma and decrease the length of hospital stay.Aim: Investigate whether the prescribed perioperative fasting time and practiced by patients is in compliance with current multimodal protocols and identify the main factors associated. Methods: Cross-sectional study with 65 patients undergoing elective surgery of the digestive tract or abdominal wall. We investigated the fasting time in the perioperative period, hunger and thirst reports, physical status, diabetes diagnosis, type of surgery and anesthesia.Results: The patients were between 19 and 87 years, mostly female (73.8%). The most performed procedure was cholecystectomy (47.69%) and general anesthesia the most used (89.23%). The most common approach was to start fasting from midnight for liquids and solids, and most of the patients received grade II (64.6%) to the physical state. The real fasting average time was 16 h (9.5-41.58) was higher than prescribed (11 h, 6.58 -26.75). The patients submitted to surgery in the afternoon were in more fasting time than those who did in the morning (p<0.001). The intensity of hunger and thirst increased in postoperative fasting period (p=0.010 and 0.027). The average period of postoperative fasting was 18.25 h (3.33-91.83) and only 23.07% restarted feeding on the same day. Conclusion: Patients were fasted for prolonged time, higher even than the prescribed time and intensity of the signs of discomfort such as hunger and thirst increased over time. To better recovery and the patient's well-being, it is necessary to establish a preoperative fasting abbreviation protocol.

The use of mentholated popsicle to reduce thirst during preoperative fasting: A randomised controlled trial

“…The mean times of fasting for solid and liquids prior to a surgery were above the recommended by the ASA () and ERAS protocol (Gustafsson et al, ) in both groups, with approximately 8 hr above the recommended for liquids and 7 hr above the recommended for solids. These observations were similar to studies conducted in other countries (Abebe et al, ; Aguilar‐Nascimento et al, ; Francisco et al, ; Gul et al, ). Thirst in these patients is not only due to the duration of fasting, but can also be influenced by anxiety, medication type and age, for example (Arai et al, ; Conchon et al, ; Leiper, ).…”

“…Research on the patients' experience of thirst within hospital settings has found a high prevalence of the symptom in surgical patients, varying from 75% (Aroni, Nascimento, & Fonseca, 2012)-98% (Serato et al, 2019) during the postoperative period, and from 43% (Gul, Andsoy, & Ozkaya, 2018)-69% (Francisco, Batista, & Pena, 2015) during the preoperative period. In the surgical patient, the experience of thirst is particularly unpleasant, with reports that it can give the sensation of suffocation, weakness, irritation, desperation, fear and anxiety.…”

“…There is evidence in the literature that surgical patients frequently fast for longer periods than necessary, both on the preoperative and postoperative periods (Abebe et al, 2016;Aguilar-Nascimento et al, 2014;Francisco et al, 2015;Gul et al, 2018;Tosun, Yava, & Açikel, 2015). This procedure negatively affects the surgical recovery and induces thirst in the patient (Abebe et al, 2016;ASA, 2017;Francisco et al, 2015;Gul et al, 2018).…”

The Effect of Nursing Intervention of Postoperative Thirst in Patients after Laparoscopic Cholecystectomy

“…Perioperative fasting is a regular method to reduce risk of anesthesia in the operation and postoperative complications. Extensive researches at home and abroad have proved that thirst occurs in most patients after operation because of perioperative fasting [3]. Koeppe, A. T. et al [4] reported 12 patients with 10 having undergone laparoscopic surgery think postoperative dry mouth and thirst are hard to bear in the interview.…”

Advances in the Management of Perioperative Patients' Thirst

“…International protocols indicate a need for a drastic reduction in perioperative fasting and recommend that patients ingest clear liquids up to two hours before surgery, with early reintroduction in the IPP . However, in some health institutions in different countries, compliance with shortened fasting time remains low …”