Jeffrey Blank, DPM, as nonsensical. "Sterile is sterile," says Dr.
Blank, of the Dundee Foot & Ankle Center in Wheeling, Ill. "If flash-
ing is ever acceptable, then it should always be acceptable."
Concerns about the logic echoed from as far away as Australia. "A
flash sterilizer is better than waiting for an hour or so to get a dropped
instrument re-sterilized," says Ian Skinner, MBBS, FRACS, FAOA, of
the Orthopaedic Surgery Institute of Western Australia. "In my view,
the time spent with the patient anesthetized and (with the) wound
open is a greater risk of infection and/or complication than the threat
of a flash sterilizer. Even if the instrument is hollow, what chance is
there that the interstices were contaminated when it was dropped?"
Fast times
NPO guidelines have been evolving in recent years. but as William
Landess, CRNA, MS, JD, notes, "some cling to the old standards." The
nothing-after-midnight proclamation was based on "old, questionable
research," says Mr. Landess, the corporate director of anesthesia at
Palmetto Health in Columbia, S.C. How old? "The guidelines were
established more than 150 years ago for patients in labor," says Gary
Lawson, MD, chief medical officer for Quantum Anesthesia Services in
Naples, Fla.
If guidelines are evolving, but patients are still being told to fast for
8 hours or more, who's to blame? "It seems that patients are kept NPO
for surgeon convenience," says a nurse manager from Kentucky, "in
case the procedure can be done earlier than planned. The rule is actu-
ally bad for patients. That's what bothers me the most."
Patients who take clear carbohydrate liquids up to 3 hours pre-oper-
atively recover faster, have less PONV, spend less time in PACU and
have greater satisfaction, says Kris Sabo, RN, executive director and
administrator of Pend Oreille Surgery Center in Ponderay, Idaho,
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