Preoperative fasting: Is it based on evidence?
The rule ‘Nil by Mouth’ from midnight is used traditionally to ensure that the stomach is empty prior to induction of anaesthesia. It is clearly stated that during induction of anaesthesia, the protective laryngeal reflex is diminished, which maximises the risk of pulmonary aspiration. Even in the early days of the anaesthetic era, most people understood that prior to surgery, no intake of solid food was to be consumed. (Ljunggvist&Soreide, 2003)
Ljungvvist&Soreide (2003) explains that surgical authorities recommended that patients have fluids containing carbohydrates, for example, beef tea, during the preoperative period. In spite of ...view middle of the document...
The essay topic was chosen due to a great interest in the area of perioperative nursing. References in this essay may be out-dated. However, when undertaking searches for this essay, the author found that the evidence is very similar to recent articles found.
In recent times, patients have been fasted from food and drink for times of up to eight and twelve hours prior to anaesthesia. This has been routine in order to reduce the risk of aspiration and regurgitation during induction of anaesthesia. Regardless of the evidence suggesting that shortened fasts do not increase the possibility of a harmful event, current practice still has variations across the United Kingdom. Benefits of reduced fasting times, maximised patient comfort and also hydration. This guideline not only focuses on reviewing current evidence available with regards to current fasting times, but it also looks at encouraging changes in practice for the benefit of patients. (RCN, 2005)
It is a requirement that all patients undergoing surgery must fast prior to induction of anaesthesia. Periods of fasting within hospitals are followed to suit guidelines but not to suit patients. The most commonly used fasting regime was stated by Bothamley et al (2005) as Nil by Mouth from midnight, with an allowance of clear fluids 2 hours prior to surgery. Bothamley et al (2005) suggests that this regime is followed to ensure that there has been enough time allowed for gastric emptying to avoid aspiration and regurgitation. However, results from 38 randomised controlled trials showed that there is no definite evidence that shortening the time allowed for fluids resulted in an increased risk of aspiration, regurgitation or related morbidity. This was in comparison with the standard Nil By Mouth fasting policy. (Bothamley et al 2005).
Preparing patients for surgery is a major part of nursing care. The way in which nurses manage patients who are Nil by Mouth is important. This is because fasting preoperatively can affect patients both physically and psychologically. Persistent fasting times can be due to a variety of reasons. For example, deficient knowledge of correct fasting times from staff; cancelled theatre lists and also poor communication between theatre staff and ward staff. (Whiteing and hunter, 2008) Hung (1992) indicates that nurses do not study enough around the importance of preoperative fasting. remain a problem.Winkley (1998) states that nurses may havedifficulty finding the time and also finding the resources to read which consists of research surrounding preoperative fasting. Nolan et al (1998) points out that it is expectant that nurses read resources which contains current research around preoperative fasting in order to encourage evidence based nursing.
O’Callaghan (2002) states that patients are fasted for increased amounts of time prior to surgery. Complications can arise when patients are fasted excessively prior to surgery. Some of the complications can range from...