M. Lou Marsh, MD
ANESTHESIA ALERT
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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.
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