Preoperative Fasting Time Research Articles

Preoperative Snack Prescription: A Single-Centre Experience in Optimising Preoperative Fasting Time and Enhancing Guideline Adherence.

Objectives Preoperative fasting plays a pivotal role in adequately preparing patients for anaesthesia and surgical procedures. However, it is imperative to consider not only the medical aspects but also patients' overall comfort, as this can significantly contribute to improved surgical outcome. The primary objective of this quality improvement project (QIP) is to provide healthcare professionals, including anaesthetists, surgeons, nurses, and stakeholders withinformation regarding insights required to embrace the concept of preoperative snack prescription as a strategy for enhancing patient-centred care. Methods This QIP was conducted in the vascular surgery department of a district general hospital in Wales, United Kingdom. A prospective analysis was conducted in two cycles, i.e., the pre-intervention group (PrIG) and post-intervention group (PoIG), with preoperative snacks such as biscuits, chips, or cakes, being prescribed to the PoIG. A total of 40 patients who met the inclusioncriteria were enrolled in this study, with 20 patients participating in each cycle. The timing of preoperative meals, i.e., the closest preoperative breakfast, lunch, or dinner, preoperative snacks (for the PoIG), anaesthesia commencement, and surgical commencement were collected. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), in conjunction with Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). Results In our QIP, the PrIG and PoIG comprised 40% (8 out of 20) and 35% (7 out of 20) female patients, respectively, with mean ages of 74 years (range, 61-86 years) and 61.3 years (range, 36-81 years). Within the PrIG, the mean duration from the preoperative mealto anaesthesia and surgery commencement was 17.8 hours (range, 14.6-22.5 hours) and 18.5 hours (range, 16.0-23.3 hours), respectively. In the PoIG, following the initiation of preoperative snack prescription, the mean time intervals between preoperative snack prescription and anaesthesia and surgery commencement were 10.9 hours (range, 6.5-16.0 hours) and 12.0 hours (range, 7.5-16.5 hours), respectively. Conclusions In summary, our QIPhas successfully integrated preoperative snack prescription into the local hospital's preoperative care policy, prioritising the balance between patient safety and comfort. Based on our single-centre experience, we observed a significant reduction in the time interval between preoperative fasting and the initiation of anaesthesia, decreasing from 18.3 hours to 10.9 hours post-implementation of preoperative snacks. This QIP holds relevance for healthcare professionals as it underscores the benefits of shorter fasting periods, which contribute to heightened patient satisfaction and comfort.

Nursing measures in the fast-track surgery on negative emotions in breast cancer patients: A meta-analysis.

To critically evaluate the effects of different nursing measures based on the concept of fast-track surgery (FTS) on the negative emotions of patients with breast cancer. A systematic search of 8 databases, namely PubMed, Cochrane Library, Embase, Psycho info, China national knowledge infrastructure, Wanfang, China science and technology journal database, and China biomedical literature database, was performed to find randomized controlled trials from inception to April 2023. Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed form. All analyses were performed with Review Manager 5.3. Ten studies were included in the systematic review, with a total of 830 patients (FTS group: 415; control group: 415). The results showed that different nursing measures based on the concept of FTS could significantly reduce anxiety (MD = -1.74, 95% confidence intervals [-2.41, -1.08], P < .00001) and depression (MD = -1.98, 95% confidence intervals [-2.44, -1.51], P < .00001) in patients after modified breast cancer surgery compared with the control group. Based on the concept of FTS, the nursing measures such as reducing preoperative fasting time, posture management, preventive analgesia, and early functional exercise can effectively reduce the anxiety and depression of patients during the perioperative period.

Importance of fasting abbreviation and analgesia in the satisfaction and recovery of elderly patients with hip and femur fractures. retrospective study with 1,001 patients

Background and objectives: There are several ways to assess patient satisfaction, as it is a standard indicator of the quality of care provided. The aim of this study was to evaluate whether the abbreviation of fasting with 200 ml CHO, the intake of the same beverage in the PACU, the return to oral feeding in the ward, and postoperative analgesia can improve comfort and satisfaction with anesthesia in elderly patients. with hip and femur fracture. Methods: A retrospective trial carried out in a Brazilian public health hospital (SUS), with 1,001 patients physical status ASA I-III submitted to hip and femur fracture surgery. The following items were evaluated: preoperative fasting time, evaluation of thirst and hunger upon arrival in the operating room, time of CHO administration in the PACU, time of reintroduction of oral feeding in the ward, and at this moment, the degree of satisfaction with the anesthetic conduct, abbreviation of fasting and early feeding. A satisfaction assessment was performed with YES and NO answers regarding the pre-anesthetic visit, the fasting abbreviation, the use of CHO in PACU, refeeding in the ward, and postoperative analgesia. Family members were also asked to return immediately to the ward, without intravenous hydration and without going through the ICU. Results: All patients had the fasting abbreviation between 1:20 h and 4:00 h. None of the 1,001 patients reported being thirsty when they arrived in the operating room, against only 26 patients reporting being hungry. The time of administration of dextrinomaltose in PACU ranged from 20 minutes to 5:45 h, and the reintroduction of oral feeding in the ward ranged from 4 h to 8:15 h. Analgesia with lumbar plexus block with a neurostimulator and levobupivacaine before or after providing mean analgesia of 22±4 h, with a minimum time of 13 h and a maximum of 34 h. All patients were able to be discharged from the hospital on the second postoperative day. Conclusion: This study with 1,001 patients clearly shows that in hospitalized elderly, the liberal use of CHO before surgery and immediately in PACU, and better quality analgesia is an easy and practical way to increase patient comfort and satisfaction with anesthesia care and with better outcomes.

Unrestricted drinking before surgery: a structured patient interview.

Our recent study [1] showed that unrestricted drinking before surgery, and its implementation using fasting cards, shortened the median pre-operative liquid fasting time to 2.1 h. Although adherence to the guidelines was significantly improved, critics questioned whether patients drink too much liquid immediately before induction of anaesthesia. Therefore, we evaluated our study data regarding patients' drinking behaviour. In the third PDSA cycle [1], 25 weeks after the implementation of fasting cards, 143 patients underwent a structured interview. The results are summarised in Table 1. On the day of surgery, 130 (91%) patients had drunk at least 100 ml of liquid or at least 2 ml.kg−1 if they were children. The minimum time interval between drinking clear liquids and induction of anaesthesia was 25 min (Fig. 1). The median (IQR [range]) volume of the last liquid intake before induction of anaesthesia was 200 (150–250 [50–500]) ml. Patients were asked about the total amount drunk on the day of surgery. Of 108 patients, six had not drunk anything at all, two patients had only taken a few sips with their morning medication and two infants had drunk 50 ml each. Of the remaining 98 patients, the median (IQR [range]) pre-operative cumulative drinking volume was 400 (200–500 [100–1500]) ml, and was higher when anaesthesia was induced later in the day. Patients with induction of anaesthesia before 11.00 (n = 44) had drunk a median (IQR [range]) of 250 (200–363 [100–500]) ml, while patients with induction of anaesthesia after 11.00 (n = 54) had drunk a median (IQR [range]) of 500 (400–750 [100–1500]) ml; p < 0.0001. Regarding drinking quantities, patients drank small amounts repeatedly, hence the pre-operative total liquid intake increased as the day went on. Patients who usually drink little and may still be worried about urinary urgency also drink little pre-operatively. For them, small sips are enough to reduce thirst and dry mouth [2]. Thus, the lowest pre-operative cumulative drinking volume at anaesthetic induction, both before and after 11.00, was 100 ml. Other patients liked to drink more during the day; the largest cumulative total when anaesthetic induction was after 11.00 was 1500 ml, which was three times the largest cumulative total when anaesthetic induction was before 11.00 (500 ml). For elderly patients in particular, it is important to drink in the morning; these patients consume about 60% of their daily liquid intake between 05.00 and 13.00 and another 30% until 19.00. They might intentionally avoid drinking in the evening because they are concerned regarding night-time incontinence [3]. Therefore, the risk of peri-operative dehydration in this group is relatively high. Prolonged deprivation of fluids harms patients [4], but forcing them to drink more than they want to, for example in the context of studies with rigid drinking instructions, makes them uncomfortable. Patients who drank an amount they were used to had less anxiety [2], and anxiety regarding their operation is the most troublesome aspect for many patients [5]. Unrestricted drinking before surgery allows patients to drink on the day of surgery in the manner they are used to and find comfortable. Therefore, only 3.5% of our study patients reported severe thirst, even though thirst appears to be the most frequent feature of peri-operative discomfort [5]. Unrestricted intake of clear liquids before induction of anaesthesia has been shown to reduce the incidence of postoperative nausea and vomiting [6, 7], a predictor of patient dissatisfaction with anaesthesia [7, 8]. Only 2.8% of our patients required an anti-emetic in the recovery room. Our study has some limitations. In the interviews, the patients were able to state the time of the last liquid intake very precisely. However, the amount of liquid last drunk sometimes referred to a time-period rather than a time-point. Thus, the last amount of liquid consumed may have been overestimated. Data on the total amount drunk on the day of surgery were not available for 35 patients as this question was only added to the interview on the second day of the survey. In summary, patients were allowed unrestricted drinking before surgery, drank wisely and according to their needs. The amount and type of liquid desired were highly individual. This liberal liquid regime may prevent peri-operative anxiety, stress, postoperative nausea and vomiting, postoperative delirium and other complications. No competing interests declared. Open Access funding enabled and organized by Projekt DEAL.

Difference of ketone levels between diurnal and nocturnal fasting in children: an observational study

Introduction: Children are susceptible to developing preoperative ketonemia, which can be affected by changes in the circadian rhythm and counter-regulatory hormones. It is unclear whether ketonemia depends on the timing of fasting.&#x0D; Objective: To assess the effect of preoperative fasting time (diurnal vs. night) on the preoperative concentration of ketone bodies in children.&#x0D; Methods: We conducted a prospective-observational clinical study between September 2020 and March 2021, including children under 48 months of age scheduled for elective surgery. Two groups were identified based on fasting time, as follows: diurnal fasting (group A, n = 40) and nocturnal fasting (group B, n = 52). Demographic data, duration of fasting, time of excess fasting, type of food intake, the concentration of ketone bodies and capillary blood glucose, level of anxiety, and dehydration were analyzed in both groups. &#x0D; Results: Diurnal fasting was associated with higher incidence of ketonemia compared with nocturnal fasting (Group A: 62.5% [95% CI 48.1-82.0]; group B: 38,5% [95% CI 26.5-52.5], P=0.02). Most of the patients exceeded the duration of fasting recommended by preoperative fasting guidelines (95.6%). The type of food eaten before surgery was significantly associated with the presence of ketonemia (P=0.01). &#x0D; Conclusions: Preoperative ketonemia is relatively common in patients under 48 months of age, especially among those who undergo diurnal fasting compared to nocturnal fasting.

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

The actual duration of preoperative fasting in pediatric patients, and its effects on hunger and thirst: a prospective observational study.

Preoperative fasting time for food and clear liquid was recommended as 2 and 6 h to prevent pulmonary aspiration. Prolonged fasting led to ketosis, hypotension, and patient discomfort. This study aimed to investigate the actual duration of preoperative fasting in pediatric patients, its effects on hunger and thirst, and factors that influence hunger and thirst. This prospective observational study recruited participants aged 0-15 years who were scheduled for elective surgery or for other procedures to be performed under general anesthesia in a tertiary care center. All parents or participants were asked to report the fasting time for food and clear liquid. Participants aged 7-15 years self-rated their degree of hunger and thirst using a 0-10 scale. For participants aged less than 7 years, parents were asked to rate their child's degree of hunger based on the child's behavior. Dextrose-containing intravenous fluid administration and anesthesia start time were collected. Three hundred and nine participants were included. The overall median [interquartile range; IQR] fasting duration for food and clear liquid was 11.1 h [IQR: 8.0, 14.0] and 10.0 h [IQR: 7.2, 12.5], respectively. The overall median hunger and thirst score was 7 [IQR: 5, 9] and 5 [IQR: 0, 7.5], respectively. High hunger score was reported in 76.4% of participants. There was no correlation between fasting time for food and hunger score [Spearman's rank correlation coefficient (Rho): -0.150, P=0.008], or between fasting time for clear liquid and thirst score (Rho: 0.007, P=0.955). Zero to 2-year-old participants had a significantly higher hunger score compared to older participants (P<0.001) and a higher proportion (80-90%) of high hunger score regardless of anesthesia start time. Although dextrose-containing fluid was administered ≥10 mL/kg, 85.7% of this group still reported high hunger score (P=0.008). Ninety percent of participants who had anesthesia start time after 12:00 PM reported high hunger score (P=0.044). The actual duration of preoperative fasting was found to be longer than the recommendation for both food and liquid in pediatric surgical population. Younger age group and anesthesia start time in the afternoon were factors associated with high hunger score.

The effect of preoperative fasting time on physiological parameters in patients undergoing thyroid surgery

The research was conducted between January 2022 and June 2022 in the Department of Surgery, Inonu University, Turkey. The sample of the study consisted of 40 consecutive patients who underwent thyroidectomy surgery. After obtaining the necessary permissions from the ethics committee, patients, and the chief physician of the medical faculty hospital, the research was conducted. Research data were collected using the patient diagnosis form, the form for assessing patients; vital signs, the form in which the laboratory values of the patients are determined, and the wound site evaluation form of patients three days after surgery. As a result of the research, it was determined that heart rate, body temperature, and HbA1c value may be affected as the fasting period gets longer. In surgeries performed in other patient groups and in patients with a higher population of thyroid surgery, it was suggested that new research should be done to examine the effect of fasting duration on vital signs, wound site, and blood laboratory values.

Measuring enhanced recovery in obstetrics: a narrative review

Enhanced recovery after cesarean delivery is a protocolized approach to perioperative care, with the aim to optimize maternal recovery after surgery. It is associated with improved maternal and neonatal outcomes, including decreased length of hospital stay, opioid consumption, pain scores, complications, increased maternal satisfaction, and increased breastfeeding success. However, the pace and enthusiasm of adoption of enhanced recovery after cesarean delivery internationally has not yet been matched with high-quality evidence demonstrating its benefit, and current studies provide low- to very low-quality evidence in support of enhanced recovery after cesarean delivery. This article provides a summary of current measures of enhanced recovery after cesarean delivery success, and optimal measures of inpatient and outpatient postpartum recovery. We summarize outcomes from 22 published enhanced recovery after cesarean delivery implementation studies and 2 meta-analyses. A variety of disparate metrics have been used to measure enhanced recovery after cesarean delivery success, including process measures (length of hospital stay, bundle compliance, preoperative fasting time, time to first mobilization, time to urinary catheter removal), maternal outcomes (patient-reported outcome measures, complications, opioid consumption, satisfaction), neonatal outcomes (breastfeeding success, Apgar scores, maternal-neonatal bonding), cost savings, and complication rates (maternal readmission rate, urinary recatheterization rate, neonatal readmission rate). A core outcome set for use in enhanced recovery after cesarean delivery studies has been developed through Delphi consensus, involving stakeholders including obstetricians, anesthesiologists, patients, and a midwife. Fifteen measures covering key aspects of enhanced recovery after cesarean delivery adoption are recommended for use in future enhanced recovery after cesarean delivery implementation studies. The use of these outcome measures could improve the quality of evidence surrounding enhanced recovery after cesarean delivery. Using evidence-based evaluation guidelines developed by the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) group, the Obstetric Quality of Recovery score (ObsQoR) was identified as the best patient-reported outcome measure for inpatient postpartum recovery. Advances in our understanding of postpartum recovery as a multidimensional and dynamic construct have opened new avenues for the identification of optimum patient-reported outcome measures in this context. The use of standardized measures such as these will facilitate pooling of data in future studies and improve overall levels of evidence surrounding enhanced recovery after cesarean delivery. Larger studies with optimal study designs, using recommended outcomes including patient-reported outcome measures, will reduce variation and improve data quality to help guide future recommendations.

Relationship between Fasting Times and Emergence Delirium in Children Undergoing Magnetic Resonance Imaging under Sedation.

Background and Objectives: This study aimed to determine whether there is a relationship between preoperative fasting time, fasting blood glucose (FBG), and postoperative emergence delirium (ED) in pediatric patients undergoing MRI under sedation. Materials and Methods: 110 pediatric patients were included in the study. Preoperative fasting (solid-fluid) time and FBG were recorded. The development of ED in the patients who underwent MRI under sedation was evaluated with the pediatric anesthesia emergence delirium (PAED) value for 30 min every 5 min in the recovery room. PAED score of ≥10 was grouped as having ED, and a PAED score of &lt;10 as without ED at any time. The PAED scores were compared with other variables, ASA, age, weight, MRI examination time, and FBG level and fasting times. The risk factors affecting the occurrence of ED were examined. Results: Mean age was 3.94 ± 1.53 years, mean FBG was 106.97 ± 12.53 mg/dL, fasting time was 10.75 ± 2.61 h, solid food fasting time was 11.92 ± 2.33 h, and thirst time was 10.74 ± 2.58 h. FBG was never associated with PAED measurement at any time (p &gt; 0.05). There was a weak positive correlation between the fasting time and the 0th, 5th, and 10th minute PAED score (r = 0.225; p = 0.018, r = 0.195; p = 0.041, r = 0.195; p = 0.041). There was a weak positive correlation between the solid food fasting time and the PAED score at the 0th, 5th, 10th, 15th, and 20th minutes (r = 0.382; p &lt; 0.001, r = 0.357; p &lt; 0.001, r = 0.345; p &lt; 0.001, r = 0.360; p &lt; 0.001, r = 0.240; p &lt; 0.001). There was a weak positive correlation between thirst time and the PAED score at the 0th, 5th, and 10th minutes (r = 0.222; p = 0.020. r = 0.192; p = 0.045, r = 0.199; p = 0.037). The incidence of ED at any time was 34.5%. Conclusions: Prolonged fasting time, solid food fasting time and thirst time are risk factors for developing postoperative ED in children undergoing MRI under sedation.

Preoperative fasting: exploring guidelines and evidence to ensure consistent, high-quality care.

Many nurses will still be familiar with the instruction 'nil by mouth from midnight' traditionally given to patients preparing to undergo surgery. National and international guidelines now promote much shorter preoperative fasting times, encapsulated in the '2-4-6 rule' - two hours for clear fluids, four hours for breast milk and six hours for solids. The latest evidence appears to show that these fasting times are in need of revision. Furthermore, there are inconsistencies in how guidelines are implemented. This article explores the guidelines and literature on preoperative fasting in adults and children to determine what the evidence is and what changes could be made to ensure consistent, high-quality patient care.

Relation between preoperative fasting time and the plestimographic variability index (PVI)

Preoperative fasting can also lead to physiological deleterious effects such as dehydration, and hypovolemia. The Plethysmographic Variability Index (PVI, Masimo Corp, Irvine, CA, USA), is a dynamic measurement and its variability could be related to hydration status. Objective: Find a correlation between the number of hours of preoperative fasting and the measurements of PVI. Studio and design: Experimental, prospective, longitudinal. Material and methods: During one-year, patients ASA I scheduled for elective general anesthesia, in an outpatient plastic surgery clinic, the nurse staff recorded PVI (%) values by MightySat® Masimo finger oximeter pulse and the hours of fasting carried out the night before their admission by direct interrogation of the patient. a simple linear regression with Pearson correlation coefficient, perfect = 1, to find a relation between fasting hours and PVI, being considered significant with a p&lt; 0.05. Results: 140 patients were included, women (90%), mean age 35 years, the mean PVI values were 21.01 (SD +/- 7.20) means hours of preoperative fasting performed by patients 11.85 (SD+/- 2.34). Pearson correlation coefficient between fasting hours and PVI was 0.005 (t-student 0.0054, p bilateral 0.47) Conclusion: This study did not show a linear relation, direct or inverse, between fasting hours and PVI values. PVI as a dynamic measurement of preload or stroke volume did not show changes in terms of fasting time in our patients.

Assessment of adherence to preoperative fasting guidelines and associated patient discomfort in adult elective surgical patients in public hospitals of Addis Ababa, Ethiopia: a multicenter cross-sectional study

Background: Preoperative fasting is compulsory before anesthesia to lower the risk of pulmonary aspiration. However, it is usually prolonged beyond the recommended time affecting the patient’s comfort and has several deleterious effects. Objective: To assess the adherence to preoperative fasting guidelines and associated patient discomfort in adult elective surgical patients in public hospitals of Addis Ababa, Ethiopia. Materials and methods: A multicenter cross-sectional study was conducted on 422 adult patients who underwent elective surgery at Addis Ababa public hospitals from February 20, to May 10, 2021. The collected data were entered into SPSS, version 24 for analysis. Spearman correlation and independent t test were used to assess the relationship between preoperative fasting time and explanatory variables, as appropriate. P value &lt;0.05 was considered as statistically significant. Results: Majority (97.4%) of patients were instructed to fast from midnight regardless of the food type and schedule. Majority (98.1%) of the participants did not adhere to the preoperative fasting guidelines. The mean preoperative fasting time was 14.26±2.35 hours (range: 8–22 h) for solid foods and 13.89±2.37 hours (range: 8–21 h) for clear fluids. More than half (64%) of the participants felt preoperative discomfort, and factors contributing were thirst, hunger, mouth dryness, lengthy waiting of prior surgery, and tiredness. There was a moderate positive correlation between preoperative fasting time and severity of patient discomfort (P&lt;0.001). There was also a strong positive correlation between total fasting time and the sequence of patient’s schedule (P&lt;0.001). Conclusions: Preoperative fasting for solids and clear liquids was longer than the recommended international fasting guidelines. Preoperative fasting duration had an association with preoperative discomforting factors. Incorrect orders of instructions and changing sequences of schedule challenged the preoperative fasting adherence. Thus, preoperative fasting instructions should be clear, individualized; and health professionals need to communicate when surgery is delayed or changed.

Unrestricted drinking before surgery: an iterative quality improvement study.

Average pre-operative fasting times for clear liquids are many times longer than those specified in national and international guidelines. We sought to decrease fasting times by applying a quality management tool aimed at continuous improvement. Through the application of iterative 'plan-do-study-act' cycles, tools to reduce pre-operative liquid fasting times were developed and applied, the effects measured, analysed and interpreted and the conclusions used to inform the next plan-do-study-act cycle. The first step was the introduction of unrestricted drinking until the patient was called to the operating theatre, with training of anaesthetic staff, adaption of local standard procedures and verbal information for patients. This did not result in short liquid fasting times, median (IQR [range]) 12.0 (9.5-14.0 [0.8-23.5]) h. In the second cycle, fasting cards were introduced as a subliminal written training tool for staff, patients and their relatives. This enabled short liquid fasting times to be achieved for outpatients (2.6 (0.8-5.1 [0.3-16]) h) and pre-admission patients (3.4 (1.8-9.4 [0.2-17.2]) h), but not for inpatients (6.5 (2.0-11.7 [0.2-16.2]) h). The third cycle included lectures for ward staff, putting up information posters throughout the hospital, revision of all written materials and provision of screencasts on the homepage for staff and patients. This decreased median liquid fasting time to 2.1 (1.2-3.8 [0.4-18.8]; p &lt; 0.0001) h, with inpatients having the shortest fasting time of 1.4 (1.1-3.8 [0.4-18.8]) h. Repeated quality improvement cycles, adapted to local context, can support sustained reductions in pre-operative liquid fasting times.

Actual Preoperative Fasting Time; A Report From Guilan Academic Hospitals: A Cross-sectional Study

Objectives: Traditional guidelines for preoperative fasting (POF) time lead to several complications in surgery patients. However, not enough attention has been paid to the issue. This aimed of this study was to investigate the management of fasting times in Guilan academic hospitals. Materials and Methods: In this descriptive cross-sectional study, individuals from five academic referral centers enrolled the survey and questionnaires including demographic characteristics, fasting hours for liquids and solids, POF recommenders, and patient’s knowledge regarding the definition of clear liquids were completed. Results: A total of 390 individuals candidate for elective surgeries enrolled in the study, the mean age of our cases were 46.61 years. The average POF time for solids and liquids was 11.43 and 9.70 hours, respectively. 95.38% of the participants did not know a correct definition of clear liquids, which was not related to their level of education (P=0.314). A positive association was observed between age and POF times for liquids and American Society of Anesthesiologists Classification for both solids (P=0.010) and liquids (P=0.0001). Conclusions: It was found that the real POF time in our hospitals was significantly longer than the modern guidelines, and needs to be corrected.

Prevalence of perioperative hypothermia and predisposing factors in a children's hospital

Aim: Perioperative hypothermia is more common in pediatric patients than in adult patients due to increased body surface area/weight ratio and limited subcutaneous fat deposits. Therefore, active and passive warming techniques are used more frequently in the surgeries applied to pediatric patients. This study presents the prevalence of perioperative hypothermia and the predisposing conditions for perioperative hypothermia in pediatric orthopedic surgeries in which active and passive warming techniques are applied.Methods: This cross-sectional, descriptive, and observational study included 102 children admitted to the pediatric orthopedic clinic of a children’s hospital. Temperature measurements were made with a calibrated infrared tympanic thermometer in all cases while they were waiting in the service room, when they entered the operation theater, when they left the operation theater and when they left the postoperative care unit. Their demographic data, hemogram and thyroid hormone parameters, preoperative fasting times related to the procedure and temperature were recorded. Also, the humidity and temperature values of the operating theater, the operation type performed, the duration of the operation, the time spent in the operating theater and the recovery time from anesthesia, were all recorded in their follow-up forms. Data analysis was done using the SPSS V21.0 and was conducted at a 95% confidence interval.Results: Hypothermia was observed in 20.58% of 102 patients included in the study. Predisposing factors for perioperative hypothermia included the fact that the patient had a diagnosis of concomitant cerebral palsy, the patient's body temperature was low in the service area, low temperature and humidity values in the operating theatre and staying in the operating theatre for a prolonged period of time.Conclusion: Although active and passive warming techniques are applied during the operation, perioperative hypothermia was observed in 20.58% of pediatric patients who underwent the orthopedic operation. Consideration of predisposing factors together with active and passive warming techniques may reduce the incidence of perioperative hypothermia.

317 Preoperative Fasting in Adults – A Quality Improvement Project at Macclesfield District General Hospital

Abstract Aim Our primary endpoint was to evaluate staff awareness of preoperative fasting guidelines. Our secondary endpoint was to evaluate patient preoperative fasting times. Method Data were collected using online close-ended survey questions from surgical ward nurses and healthcare assistants before and after implementing a multimodal campaign to raise awareness. Data were collected for patient fasting times before and after the same interventions. Interventions: Results Staff: Our interventions increased staff awareness of preoperative fasting guidelines for food by 20.6% (from 50% to 70.6%) and for clear fluids by 28.8% (30% to 58.8%). Patients Average preoperative fasting times for food before and after intervention were 12.7 and 12 hours respectively (p=0.736). For clear fluids, average fasting times before and after intervention were 6.2 hours and 4.5 hours (p=0.415). Conclusions Staff were generally unaware of the guidelines and viewed preoperative fasting solely as a safeguard against aspiration, causing adoption of a risk-averse attitude. The benefits of adequate hydration and nutritional support before surgery were overlooked. Our interventions helped raise awareness in the short term. For our next cycle, we plan to assess the efficacy of implementing long-lasting changes such as local trust guidelines and improved staff training to drive a change in attitude and awareness of preoperative fasting.

How long should the pre-operative fasting time be in patients with enteral tube nutrition?

Summary: The authors have touched a very important aspect of anesthesia and surgical practice, regarding the period of preoperative fasting for patients who are on enteral feeding. The authors recommend a fasting time between 45 min and 4 h (if the airway is to be manipulated during the procedure), is adequate to perform surgical procedures in patients with enteral tube nutrition. In other patients gastric suctioning before the procedure might be adequate.&#x0D; Key words: Adult; Elective Surgical Procedures; Enteral nutrition; Fasting; Humans; Intensive Care Units; Nutritional Status; Practice Guidelines as Topic; Preoperative Care / methods; Preoperative Period; Critical Illness / therapy; Patient Safety; Risk Management&#x0D; Citation: Useche LSV, Useche CV. How long should the pre-operative fasting time be in patients with enteral tube nutrition? Anaesth. pain intensive care 2022;26(4):576-577; DOI: 10.35975/apic.v26i4.1970__

TH6.1 Fasting times and medication administration in ‘nil by mouth’ emergency surgery patients

Abstract Aims 1) To determine whether ‘nil by mouth’ (NBM) emergency surgery patients are fasted for longer than the recommended 6 hours for food and 2 hours for clear fluids. 2) To establish whether oral medications are being correctly administered/omitted in these patients. Methods Fasting and medication administration data were collected prospectively on patients who received emergency surgery over a 2- week period. Drug administration decisions were categorised as ‘correct’ or ‘incorrect’ by comparison with local guidelines. Results A total of 65 patients were identified with the average preoperative fasting times being 24 hours for food and 14 hours for clear fluids. However, the range of fasting times exceeded 110 hours. Notably, only 16 (25%) patients had a drink while they were NBM and 29 (45%) patients were incorrectly administered medications, including several instances of omission of critical drugs. Conclusions Further work is needed to establish the cause of prolonged fasting periods. However, likely factors include; operation scheduling difficulties, lack of understanding of NBM guidelines, inadequate communication with patients, and patient choice. This is resulting in poor preoperative optimisation of patients (e.g. dehydration of patients), as well as a significant risk to patient safety with critical medications being omitted. In order to rectify the severe lack of adherence to the guidelines, we are introducing further NBM training for medical professionals in our trust, in addition to updating the current trust guideline to reflect a wider range of medications and keep up to date with current national guidance.

Abbreviated perioperative fasting management for elective fresh fracture surgery: guideline adherence analysis

BackgroundLong-term fasting for elective surgery has been proven unnecessary based on established guidelines. Instead, preoperative carbohydrate loading 2 h before surgery and recommencing oral nutrition intake as soon as possible after surgery is recommended. This study was performed to analyze the compliance with and effect of abbreviated perioperative fasting management in patients undergoing surgical repair of fresh fractures based on current guidelines.MethodsPatients with fresh fractures were retrospectively analyzed from the prospectively collected database about perioperative managements based on enhanced recovery of surgery (ERAS) from May 2019 to July 2019 at our hospital. A carbohydrate-enriched beverage was recommended up to 2 h before surgery for all surgical patients except those with contraindications. Postoperatively, oral clear liquids were allowed once the patients had regained full consciousness, and solid food was allowed 1 to 2 h later according to the patients’ willingness. The perioperative fasting time was recorded and the patients’ subjective comfort with respect to thirst and hunger was assessed using an interview-assisted questionnaire.ResultsIn total, 306 patients were enrolled in this study. The compliance rate of preoperative carbohydrate loading was 71.6%, and 93.5% of patients began ingestion of oral liquids within 2 h after surgery. The median (interquartile range) preoperative fasting time for liquids and solids was 8 (5.2–12.9) and 19 (15.7–22) hours, respectively. The median postoperative fasting time for liquids and solids was 1 (0.5–1.9) and 2.8 (2.2–3.5) hours, respectively. A total of 70.3% and 74.2% of patients reported no thirst and hunger during the perioperative period, respectively. Logistic regression analysis showed that the preoperative fasting time for liquids was an independent risk factor for perioperative hunger. No risk factor was identified for perioperative thirst. No adverse events such as aspiration pneumonia or gastroesophageal reflux were observed.ConclusionsIn this study of a real clinical practice setting, abbreviated perioperative fasting management was carried out with high compliance in patients with fresh fractures. The preoperative fasting time should be further shortened to further improve patients’ subjective comfort.