Pre-operative gum chewing: forbidden, allowed or recommended.

Abstract

Drs Fawcett and Thomas clearly addressed recent advances concerning pre-operative fasting and the implications for the implementation of such recommendations in enhanced recovery after surgery (ERAS) programmes 1. However, the authors did not mention the minimal time interval that should be applied between gum chewing and induction of anaesthesia. This omission is probably due to the lack of current consensus among practice guidelines regarding this issue 2. However, gum chewing has been reported to enhance gastric emptying while reducing patient discomfort and anxiety during the pre-operative period 2. Hence, pre-operative gum chewing might be of interest to improve postoperative recovery. Recent literature suggests that postoperative gum chewing after digestive or gynaecologic surgery may offer an innovative intervention for improving postoperative recovery of gastro-intestinal function 2, 3. Nevertheless, there is little evidence about the clinical impact of gum chewing during the postoperative period in terms of reductions in patient discomfort, complications and length of hospital stay 3. The initiation of gum chewing during the immediate pre-operative period, rather than during the hours after the surgical procedure, could lead to earlier resolution of ileus and improvement of postoperative recovery. To the best of our knowledge, the potential impact of gum chewing before surgery on postoperative outcome has never been evaluated. As mentioned by Drs Fawcett and Thomas in their review 1, antral ultrasonography has been proposed for the assessment of gastric content and volume in various surgical populations 4-6. Using this tool, we have recently demonstrated in healthy volunteers that gum chewing was not associated with increased gastric fluid volume measured 2 h after the oral intake of 250 ml of water 7. Hence, pre-operative chewing gum does probably not increase the risk of pulmonary aspiration of gastric content and could be considered as a safe practice. Future practice guidelines on pre-operative fasting should give up-to-date recommendations concerning gum chewing that allow this practice during the hours before elective surgery. Such recommendations are probably a pre-requisite for the initiation of future clinical trials assessing the potential benefits of pre-operative gum chewing on postoperative outcomes after abdominal surgeries. In a few years, one cannot exclude the possibility that this practice could be recommended and integrated in different enhanced recovery programmes.