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What Will the OR of the Future Look Like? - July 2014 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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M. Lou Marsh, MD ANESTHESIA ALERT 3 2 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U LY 2 0 1 4 Why Starve and Dehydrate Your Patients? You are if you're forcing them to fast from midnight. A recent AORN Journal article estimates the average surgical patient fasts for 11 hours. Total abstinence typically starts at midnight before the day of surgery — no matter the actual time of the scheduled procedure. While we can clinically justify pro- longed fasting from solids, similar fasting from clear liquids is a non- evidence-based dinosaur that begs for extinction. What's so special about midnight? Fifteen years ago, the American Society of Anesthesiologists (ASA) published its first Fasting Guidelines for Healthy Patients Having Elective Surgery, essentially targeting the majority of patients with whom we deal every day. Based on best evidence and expert opin- ions, the ASA declared it safe for such patients to "have clear liquids up to 2 hours prior to surgery." Many hospitals and surgery centers rushed to make those guidelines a part of their policy and procedure manuals. Today, however few surgical facilities have actually implemented their "new fasting guidelines." An Outpatient Surgery Magazine online survey of 516 surgical facility leaders found that most are subjecting their patients to the unpleasant, if not grueling, consequences of a pre-opera- tive fast that may last for 12 to 16-plus hours, depending on the actual start times of their procedures. • 54% follow the traditional NPO: nothing by mouth from midnight for all patients. • 28% say no solids after midnight, but clear liquids up to a few hours before surgery are okay. • 18% allow a light breakfast up to 6 hours before surgery and clear liq- uids up to 2 hours before surgery. OSE_1407_part1_Layout 1 7/3/14 9:00 AM Page 32

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