Pre-operative fasting and administration of regular medications in adult patients presenting for elective surgery. Has the new evidence changed practice?

Pearse, Rupert M; Rajakulendran, Y.

doi:10.1097/00003643-199908000-00013

Cited by 29 publications

(2 citation statements)

References 12 publications

(3 reference statements)

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“…Over the years, a lot of research has been conducted to establish fasting guidelines prior to anaesthesia to reduce the risk of GOR. The traditional guideline was nil by mouth (NPO) from midnight if the surgery was scheduled for the morning, and toast with a tea (light breakfast) for the patients who were scheduled for the afternoon [23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Intraoperative Gastro-Oesophageal Reflux in Dogs and Cats

Savvas

Pavlidou

Anagnostou

et al. 2022

Animals

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In animals, gastro-oesophageal reflux (GOR) may occur during anaesthesia, and it can lead to severe consequences such as oesophagitis and oesophageal stricture. This systematic review investigates the effect of fasting duration and anaesthetic and nonanaesthetic drugs on GOR in dogs and cats during general anaesthesia. Fifteen clinical studies met the inclusion criteria in this systematic review. In thirteen studies the population was dogs, while in two studies the population was cats. In the meta-analysis, seven studies were included. Four studies on the effect of fasting duration on GOR in dogs were included in the meta-analysis. In total, 191 dogs had a fasting duration less than 5 h, while 311 dogs had a fasting duration more than 5 h. The heterogeneity of the studies was high and statistically significant (p = 0.0002, I2 = 85%), but the overall effect was statistically nonsignificant (p = 0.82, odds ratio = 0.81, 95% CI 0.15, 4.26), in favour of the low fasting duration (<5 h). Concerning the effect of antacids on GOR, three studies were included in the meta-analysis. The heterogeneity of the studies was low and nonsignificant (p = 0.13, I2 = 52%) and the overall effect was statistically nonsignificant (p = 0.24). The low number of studies and the diverse factors affecting the incidence of reflux prevented us from reaching valuable conclusions on the risk factors for GOR.

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Section: Introductionmentioning

confidence: 99%

Factors Affecting Intraoperative Gastro-Oesophageal Reflux in Dogs and Cats

Savvas

Pavlidou

Anagnostou

et al. 2022

Animals

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“…Studies show up to half of these medications are omitted inappropriately during the perioperative period, which can place patients at risk of undesirable complications. [1][2][3][4][5][6][7] To improve pre-procedural medication management, organisations have advocated continuation of oral medications unless advised to the contrary, 8 9 and evidencebased guidelines recommending which medications to continue or withhold have been produced. 10 11 Other strategies such as targeted education of nursing staff about perioperative medication guidelines and pharmacist intervention have also been instigated.…”

Section: Introductionmentioning

confidence: 99%

Impact of a policy to improve the management of oral medications when patients are fasting before a procedure: an interrupted time series analysis

Braat

Lim

et al. 2022

BMJ Open Qual

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BackgroundManaging medications inappropriately when patients have oral intake restrictions can cause patient harm. This study evaluated the impact of a medication policy separating fasting from nil by mouth with respect to giving oral medications in patients fasting before a diagnostic or interventional procedure.MethodsThe policy stipulated that ‘fasting’ means oral medications should be given with a sip of water up to 1 hour before a procedure, unless there is a clinical reason to withhold, while ‘nil by mouth’ means nothing to be given orally, including medications.The policy was implemented in Surgical areas in February 2015 and Medical areas in March 2015 at a tertiary referral hospital in Melbourne, Australia, and included bedside signs, clinical champions and education sessions.The study was conducted in 2020. Admission and medication records were matched for non-elective procedure patients from January 2014 to May 2016. The monthly proportion of doses omitted inappropriately and overall omissions pre/post-policy implementation were compared using segmented regression.ResultsPre-implementation, the proportion of doses withheld inappropriately and total omissions in medical areas were 18.1% and 28.0%, respectively. Post-implementation, an absolute reduction of 13.4% (95% CI 9.0% to 17.7%) and 11.1% (95% CI 2.6% to 19.6%), respectively, was seen. Post-implementation linear trend showed a 0.3% (95% CI 0.0% to 0.6%) increase in inappropriate omissions but not overall omissions.In Surgical areas, pre-implementation proportions for inappropriate and overall omissions were lower than Medical areas’. Post-implementation, there was an absolute decrease in doses withheld inappropriately (8.3%, 95% CI 0.8% to 15.7%, from 11.9% pre-implementation) but not total omissions.ConclusionsDistinguishing fasting from nil by mouth appeared to provide clarity for some staff: a reduction in inappropriate omissions was seen post-implementation. Although the small increase in post-implementation linear trend for inappropriate omissions in Medical areas suggests sustainability issues, total omissions were sustained. The policy’s concepts require verification beyond our institution.

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Preoperative fasting for adults to prevent perioperative complications

Brady

Kinn²,

Stuart

et al. 2003

Cochrane Database of Systematic Reviews

478

340

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There was no evidence to suggest a shortened fluid fast results in an increased risk of aspiration, regurgitation or related morbidity compared with the standard 'nil by mouth from midnight' fasting policy. Permitting patients to drink water preoperatively resulted in significantly lower gastric volumes. Clinicians should be encouraged to appraise this evidence for themselves and when necessary adjust any remaining standard fasting policies (nil-by-mouth from midnight) for patients that are not considered 'at-risk' during anaesthesia.

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Pre-operative fasting and administration of regular medications in adult patients presenting for elective surgery. Has the new evidence changed practice?

Cited by 29 publications

References 12 publications

Factors Affecting Intraoperative Gastro-Oesophageal Reflux in Dogs and Cats

Factors Affecting Intraoperative Gastro-Oesophageal Reflux in Dogs and Cats

Impact of a policy to improve the management of oral medications when patients are fasting before a procedure: an interrupted time series analysis

Preoperative fasting for adults to prevent perioperative complications

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