The Effects of Chewing Gum on Gastric Content Prior to Induction of General Anesthesia

Søreide, Eldar; Holst-Larsen, H; Veel, Terje; Steen, Petter Andreas

doi:10.1213/00000539-199505000-00023

Cited by 15 publications

(29 citation statements)

References 19 publications

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“…Habitual smokers have a small but statistical significant increase in gastric fluid volumes when compared with non-smokers, even when refraining from smoking (30). To what extent smoking affects gastric fluid emptying and volume is still controversial, but overall there seems to be good reasons for avoiding smoking immediately before anaesthesia (24,30,31) Recreational abuse of cannabinoids (32) and high doses of alcohol (33) also inhibit gastric emptying. Functional dyspepsia (34)(35)(36) is associated with a delay in gastric emptying.…”

Section: Gastric Emptyingmentioning

confidence: 99%

“…Further, although shown to affect gastric content not all national societies guidelines include information on the use of chewing gum, tobacco and pre-operative medications in the immediate pre-operative period. Chewing gum and tobacco use both increase gastric content, but to what extent the increase is of any clinical significance is very uncertain (30). Still, we think their use should be discouraged in the immediate preoperative period (14).…”

Section: National and Anaesthesia Society Guidelinesmentioning

confidence: 99%

See 1 more Smart Citation

Pre‐operative fasting guidelines: an update

Søreide

Eriksson

Hirlekar

et al. 2005

Acta Anaesthesiol Scand

227

106

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Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children <6 months, most recommendations now allow breast-or formula milk feeding up to 4 h before anaesthesia. Recently, the concept of pre-operative oral nutrition using a special carbohydrate-rich beverage has also gained support and been shown not to increase gastric fluid volume or acidity. Based on the available literature, our Task Force has produced new consensus-based Scandinavian guidelines for pre-operative fasting. What is still not clear is to what extent the new liberal fasting routines should apply to patients with functional dyspepsia or systematic diseases such as diabetes mellitus. Other still controversial areas include the need for and effect of fasting in emergency patients, women in labour and in association with procedures done under 'deep sedation'. We think more research on the effect of various fasting regimes in subpopulations of patients is needed before we can move one step further towards completely evidence-based pre-operative fasting guidelines. Accepted for publication 16 March 2005Key words: Anaesthesia; general; gastric content; gastric emptying; preoperative fasting; pulmonary aspiration complications. # Acta Anaesthesiologica Scandinavica 49 (2005)A NAESTHESIA-RELATED pulmonary aspiration leading to respiratory failure (Aspiration Pneumonitis; Mendelson's syndrome) has been described in both elective and emergency surgical patients (1-7). With the hope of reducing the risk of this complication, rigid fasting routines before surgery have been enforced (8). However, the scientific basis for these rigid fasting routines in elective patients has been challenged and found to be nonexistent (9-11). Based on this new information, several national anaesthesia societies now have accepted more liberal fasting rules for clear fluids (water, clear juices, coffee, tea) (12-17). Intake of solids in the morning of elective surgery is still not recommended.To what extent pre-operative fasting is of any importance in emergency cases is still a matter of uncertainty with variation in clinical practice. Further, it is also not clear to what extent specific patient populations with suspected or proven delayed gastric emptying need to be exempt from the new fasting guidelines (16,17). Recently, a new method for pre-operative optimization of the elective patient, oral nutrition with carbohydrates (16,18,19), has been introduced, but so far has not been widely implemented into clinical practice.This review aims to give an update on preoperative fasting and gastric content as a risk factor of pulmonary aspiration. We will focus on the development and experience with the new and more liberal clinical practice guidelines, but also present still controversial areas worth further research. Anaesthesia-related pulmonary aspiration: risk factors Gastric e...

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Section: Gastric Emptyingmentioning

confidence: 99%

Section: National and Anaesthesia Society Guidelinesmentioning

confidence: 99%

Pre‐operative fasting guidelines: an update

Søreide

Eriksson

Hirlekar

et al. 2005

Acta Anaesthesiol Scand

227

106

View full text Add to dashboard Cite

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“…One year later, Søreide et al (43) published similar results from a healthy adult population allowed ad lib chewing of sugarless gum until arrival in the operating room. The study compared 30 controls (no gum chewing) with 30 adults in a treatment group (sugarless gum, one piece for every hour from 7:00 am until arrival in the pre-anesthesia holding area, an average of 173 ± 76 min (range not reported).…”

Section: Anesthetic Investigations and Case Reportsmentioning

confidence: 87%

Gum chewing during pre‐anesthetic fasting

Poulton

2011

Pediatric Anesthesia

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Many ad hoc fasting guidelines for pre-anesthetic patients prohibit gum chewing. We find no evidence that gum chewing during pre-anesthetic fasting increases the volume or acidity of gastric juice in a manner that increases risk, nor that the occasional associated unreported swallowing of gum risks subsequent aspiration. On the contrary, there is evidence that gum chewing promotes gastrointestinal motility and physiologic gastric emptying. Recommendations against pre-anesthetic gum chewing do not withstand scrutiny and miss an opportunity to enhance comfort and sense of wellbeing for patients awaiting anesthesia. Gum chewing during the pre-anesthetic nil per os (NPO) period would also permit the development of gum-delivered premedications and should be permitted in children old enough to chew gum safely. Gum chewing should cease when sedatives are given and all patients should be instructed to remove any chewing gum from the mouth immediately prior to anesthetic induction.

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“…Многочисленные контролируемые иссле дования и метаанализ привели к заключению, О б з о р ы что у пациентов, которым планируется провести плановые оперативные вмешательства, прием воды или других чистых жидкостей (чай, кофе, содовая, яблочный и апельсиновый сок без мя коти) более чем за 2 часа перед введением в нар коз не увеличивает объем желудочного сока и кислотность [36][37][38][39][40][41][42][43][44][45][46][47][48]. Исследования проводили в разных странах на взрослых мужчинах и жен щинах (совершеннолетних).…”

Section: новые правила предоперационной подго товки натощакunclassified

“…Важно, что это не применимо для молока, любых других жиросодержащих жидкостей или твердых частиц. Период голодания после приема твердой пищи должен быть не менее 6 часов для обеспече ния существенной безопасности [38,[42][43][44]. Ис пользование жевательной резинки, табака увели чивает объем содержимого желудка, но пока не ясно, до каких пределов это увеличение является клинически значимым [37,45].…”

Section: новые правила предоперационной подго товки натощакunclassified

Hyperergic Aspiration Pneumonitis (Mendelson Syndrome)

Shifman¹

2006

rmt

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The Effects of Chewing Gum on Gastric Content Prior to Induction of General Anesthesia

Cited by 15 publications

References 19 publications

Pre‐operative fasting guidelines: an update

Pre‐operative fasting guidelines: an update

Gum chewing during pre‐anesthetic fasting

Hyperergic Aspiration Pneumonitis (Mendelson Syndrome)

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