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Do patients really need to fast before surgery?

Posted by:

5 July, 2011

Patients have long been told not to eat or drink for hours before surgery because of the risk of pulmonary aspiration, but is this really necessary?

Some studies have suggested that light meals and liquids are not harmful before surgery, and that fasting can sometimes cause adverse effects, but many guidelines continue to insist on complete fasting.

What do you think?

Readers' comments (13)

  • Until scientific research shows that the patient wont suffer then traditional guidelines should be followed with the exception of being able to drink water upto an hour prior to theatre.

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  • It would be good to find out if it's really safer to fast - shame to keep doing something that started decades ago 'just because'

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  • when so many patients (particularly the elderly) are at risk of malnutrition in our hospitals it is important that we try not to starve unnecessarily. However until there is overwhelming evidence to the contary we must continue to reduce the risk of patients aspirating during surgery by starving before operations. It's a difficult call when you have a patient who may be vulnerable to malnoiurishment and taking into account the possibilty of cancellation of the operation but nevertheless we should continue to follow standard guidelines regarding starving until the proof is there to do otherwise.

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  • i work on an fracture neck of femur ward and all our patients are elderly. we have been advised that if patients are starved then end up not going to theatre then to give them 2 supplement drinks as soon as possible to give them nutrients that they may have lost whilst fasting. i have also had an episode where a patient who had fasted but not long enough aspirated in theatre and ended up going to ITU.

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  • i think patient need to fast be4 surgery to avoid ileus paralitic. if they in a risk of malnutrition, we can support with parenteral nutrition.

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  • I have to say this is a particularly hated ritual amongst many, myself included. It goes against instinct to refuse someone food and drink. There is nothing worse than fasting a patient only to have the surgery cancelled and have them repeat the process later.

    However, at the moment, the weight of clinical evidence is still on the side of fasting before surgery, so until that changes, as unpallatable as it is, it will continue.

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  • I recently was cardioverted for fast AF. I was fasted for 14hrs, for 2mg of midazolam. The nurse on the ward wouldn't even allow me a small drink of water, and I missed my morning meds, one, a beta-blocker, would have improved the chances of the DCC being successful. When I questioned this, I was told it had always been done this way.
    Surely this practice should be evidence based and not 'just because'

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  • The general guidelines for the preoperative fasting in the last few years for adults undergoing
    elective surgery use, ‘the 2 and 6 rule’
    ‘2’ - Intake of water up to two hours before
    induction of anaesthesia.
    ‘6’ - A minimum preoperative fasting time of six
    hours for food (solids,milk and milk-containing
    drinks).
    Routine medications are normally allowed with some water without problem.

    Of course there are differences for higher risk groups, emergencies, etc. IV fluids are frequently commenced in high risk groups (eg. #NOFs in the elderly) to prevent dehydration. Ultimately it's up to the anaesthetist who will be administering the anaesthetic. And that can make a huge impact on the experience for the patient.

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  • Anonymous | 7-Jul-2011 4:01 pm, it IS evidence based, that is what we are talking about. As I said earlier, there is some evidence that suggests that light meals and liquids may actually be fine, however, the vast majority - as far as I am aware - still suggest that it is better to fast, with the exceptions of small amounts of clear fluids for meds, and so the status quo remains. When the balance shifts the other way, and the body of evidence suggests that eating and drinking before surgery is fine, then we will reevaluate practice, but not until then. Saying that however, I do not think the Nurses response 'it has always been done this way' was all that appropriate or helpful for you at the time.

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  • I appreciate with the information on surgery given in this post. the best thing about this post is that it gives great information on the essential factors that are needed. Nice post
    Plastic Surgery
    Breast augmentation surgeon

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  • I appreciate with the information on surgery given in this post. the best thing about this post is that it gives great information on the essential factors that are needed. Nice post
    http://www.laderma.com/

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  • I have frequent back procedures, and get frequent inaccurate, maiming,fatal,flat opposite of what I was told, out dated info ( Prozac does not work on post-menopausal women, dr didn't believe until I brought article) outdated info and complete refusal to look up new info because they can't Google. So my brain is worse and worse because two old men don't believe cerebral spinal fluid is in your brain. This is a third grade question and one told me there was no such theory. Just google Verchow - Robin space it is not hard and it is peer reviewed. So when I read you really didn't need to fast, I don't. Haven't for years. I have very dry mouth, I have to drink, I do. I even drank coffee once because the dr's 0fc 2 hrs, Had Starbucks and muffin, Was just fine. Now, I have fundoplication so I can't throw up at all. But I eat and drink lightly so that I am comfortable. Water goes right through you, it does not take 6 hours and I will not be miserable anymore. Medical people stupidly killed my husband, stupidly broke my arm, pretend to give m3 cortizone shots through my shirt.Operated on healthy vertebrae witout permission because the doc just "did that" as a "custom"Smell fraud. So I research so shouldyou. You can drink water, it doesn;t sit in stomach forever,askyour doctor make him look it up, I cannot see. Susan

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  • I think firm evidence based guidelines need to be established and strictly adhered to. it is not acceptable to expect pts. to fast longer than the prescribed time for postponed or cancelled operations, etc. It is also unpleasant and could be dangerous to go into surgery with a full stomach.

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