Perioperative fasting: A time to relook

Subrahmanyam, M; Venugopal, M

doi:10.4103/0019-5049.71021

Cited by 6 publications

(7 citation statements)

References 8 publications

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“…[ 18 ] This has been found to effectively combat irritability, hunger, and anxiety in the perioperative period without increasing the risk of aspiration in patients without additional risk factors. [ 19 ] It is known that increasing the number of hours of preoperative fasting maybe counterproductive in terms of patient morbidity, namely, glycaemic control and hydration. Hence, we propose that all patients be screened routinely by means of a gastric ultrasound and additional measures be taken for patients who are at risk for aspiration.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: A clinical audit

Sharma¹,

Deo²,

Raman³

2018

Indian J Anaesth

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Background and Aims:An audit was conducted between July 2017 and November 2017 to assess the adequacy of American Society of Anesthesiologists (ASA) fasting guidelines on 246 patients by means of gastric ultrasonography (USG). The relevance of this audit is that many of our patients have one or more risk factors for aspiration such as diabetes mellitus, chronic kidney disease (CKD), gastro-oesophageal reflux disease (GERD), and obesity.Methods:This audit was a prospective observational study which included all patients posted for surgery within the audit period. Patients were fasted according to ASA fasting guidelines. Their gastric content was assessed preoperatively using USG. The residual gastric volume was calculated using a validated formula. Statistical correlation between gastric volumes and the risk factors were analysed.Results:Of 246 patients, 69 (28.04%) had high residual gastric volume. We found no correlation between hours of fasting and residual gastric volume (P = 0.47). We found a linear correlation between rising body mass index and residual gastric volume (P < 0.0001). Patients with GERD had 2.3 times higher risk. The CKD patient subgroup had 24 patients (30%) with high residual gastric volume. No incidents of aspiration were noted.Conclusion:In our audit, we found that risk factor association has a greater effect on residual gastric volume than hours of fasting. While the current fasting guidelines are adequate for healthy individuals, they are not conclusive in patients with risk factors. Ultrasound assessment of preoperative gastric volume is an effective screening tool in patients with risk factors.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of standard fasting guidelines as assessed by gastric ultrasound examination: A clinical audit

Sharma¹,

Deo²,

Raman³

2018

Indian J Anaesth

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“…Despite the guidelines, fasting periods are often exceeded in pediatrics [5]. Long periods of fasting in children, however, may lead to symptoms of dehydration or discomfort [6], thus exceeding the fasting time may be more harmful than useful.…”

Section: Discussionmentioning

confidence: 99%

“…By direct observation of gastric contents in children with a foreign body, we found that the patients had empty stomachs despite not adhering to the fasting guidelines. With mounting evidence questioning the benefits of long durations of fasting in decreasing the risk of aspiration, and with studies showing that fasting for more than 2 hours after ingestion of clear fluid does not significantly alter gastric pH or volume [5]; these incidental findings raise the question of whether it is safe to keep children NPO for a shorter duration before the administration of anesthesia and whether the current guidelines are in need of revision. Our case report presents cases that may reinforce a more liberal approach to preoperative fasting as it reflects a potential exaggeration in fasting time for solids but is indeed not enough to support any changes to the current recommendations.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Fasting Guidelines in Children: Should They Be Revised?

Kafrouni

Ojaimi

2018

Case Reports in Anesthesiology

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Children presenting with ingestion of foreign bodies need gastroscopy as a primary management modality. A controversy lies regarding guidelines for preoperative fasting among children with low risk of aspiration and intraoperative complications. This case report represents cases of children who ingested foreign bodies and underwent fasting at different times preoperatively. With mounting evidence questioning the benefits of long durations of fasting in decreasing the risk of aspiration and with studies showing that fasting for more than 2 hours after ingestion of clear fluid does not significantly alter gastric pH or volume, these incidental findings raise the question of whether it is safe to keep children NPO, for a shorter duration before the administration of anesthesia. In addition, this report shows that current guidelines are in need of revision.

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“…Digestion period is subject to the kind of consumed food, the fasting time around 6 h is enough for making sure of gastric depletion, and it has been proved that such a long stretching of fast is unnecessary for liquids consumption before surgery (6,7). Liquids and water remain in stomach for only 12 minutes and surveys have revealed that the volume and PH of stomach or plasma osmolarity would not be affected by unlimited water intake until 2 h prior to surgery (8). Long time fast affects the patients' physical and mental health and leads to many harms and restlessness before and after the surgery (1).…”

Section: Introductionmentioning

confidence: 99%

“…These evidences appear more quickly among the younger and the elderly patients and are more harmful. To prevent these indications could avoid surgery cancelation and anesthesia (8,1).…”

Section: Introductionmentioning

confidence: 99%