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.
Highlights
Elective surgery is a trauma which occurs catabolic process and changes in immune and inflammatory systems, in order to restore homeostasis and repair the damages tissues[9,21,28]
Prolonged preoperative fasting with hypercatabolism caused by metabolic stress of the surgical trauma induces damage in the nutritional status or exacerbation of possible previous malnutrition
The American Society of Anesthesiologists (ASA) recommends in their practical guide, that the preoperative fasting should be 2 h to zero of liquid diet enriched with carbohydrates without waste, with or without nutritional content, for example water, tea, coffee juices fruits without pulp and beverages rich in carbohydrates before elective procedures requiring general anesthesia or local sedation
Summary
Elective surgery is a trauma which occurs catabolic process and changes in immune and inflammatory systems, in order to restore homeostasis and repair the damages tissues[9,21,28]. Prolonged preoperative fasting with hypercatabolism caused by metabolic stress of the surgical trauma induces damage in the nutritional status or exacerbation of possible previous malnutrition. Besides that, this process could increase the insulin resistance, risk of infection, decrease intestinal integrity or impairment of the healing process and could prolong the hospital stay[4,25,29,30]. The American Society of Anesthesiologists (ASA) recommends in their practical guide, (published in 1999 and revised in 2011) that the preoperative fasting should be 2 h to zero of liquid diet enriched with carbohydrates without waste, with or without nutritional content, for example water, tea, coffee juices fruits without pulp and beverages rich in carbohydrates before elective procedures requiring general anesthesia or local sedation. The recommendation is 6 h for snacks and 8 h for meals[10,23]
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