- Joined
- Jan 15, 2003
- Messages
- 28
- Reaction score
- 0
How long do you wait before an elective GA case?
How long do you wait before an elective GA case?
How long do you wait before an elective GA case?
Stevin A. Dubin MD, Holly G. Jense MD,
Sugarless gum chewing before surgery does not increase gastric fluid volume or acidity.
CAN J ANAESTH 1994 / 41: 7 / pp 603-6
i just talked to someone who works at a plastic surgery office who absolutely says they won't take cases when they are chewing gum the morning of surgery. says the gastric secretions are too much.
And that's why these people work at a plastic surgeon's office and they should not work anywhere else.
Stevin A. Dubin MD, Holly G. Jense MD,
Sugarless gum chewing before surgery does not increase gastric fluid volume or acidity.
CAN J ANAESTH 1994 / 41: 7 / pp 603-6
i just talked to someone who works at a plastic surgery office who absolutely says they won't take cases when they are chewing gum the morning of surgery. says the gastric secretions are too much.
I don't cancel a case for chewing gum. I ask the patient to spit out the gum and consider Zantac/Pepcid plus Reglan. Usually, the patient will be in the holding area well in advance of the surgery so an hour or more has passed until induction.
Perhaps, the E.T. tube should be considered over an LMA? Perhaps, not.
I believe the evidence for "cancellation" due to gum chewing is weak and unsubstantiated.
If you believe and follow the studies done to date, famotidine works better but you still gotta wait at least two hours for the drugs to work properly. If you consider gum a "clear", then the two hours is a wash anyway.
Might be better served simply telling them to spit the gum out, drink 4 oz of water, then wait two hours before you induce.
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
-copro
I would tell them to spit it out and do exactly what I would have done if they were not chewing gum.So lets say that you walk out to the holding room and the patient is chewing a wad of gum. Are you going to delay the case?
FWIW, if chewing gum raises pH (according to this study), and we give bicitra to raise pH in preggos, what's the difference? harm? i had this same discussion with an attending the other day, and we both came to the same result that we would not delay case for such an example.PEDIATRIC ANESTHESIA
Residual Gastric Fluid Volume and Chewing Gum Before Surgery
Renate C. Schoenfelder, MD*, Chandra M. Ponnamma, MD*, David Freyle, MD*, Shu-Ming Wang, MD*, and Zeev N. Kain, MD, MBA*
[SIZE=-1]*Center for the Advancement of Perioperative Health and the Departments ofAnesthesiology,Pediatrics, andChild Psychiatry, Yale University School of Medicine, New Haven, Connecticut [/SIZE]
[SIZE=-1]Address correspondence and reprint requests to Renate Schoenfelder, MD, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8051. Address e-mail to [email protected] .[/SIZE] In this study we sought to determine if chewing gum preoperatively increases gastric fluid volume (GFV) and changes gastric acidity. Children, 517 yr old, were randomized to one of three groups: a control group that was not given any gum, a group that was given sugarless bubble gum, and a group that was given sugared bubble gum. Patients in the two gum groups were instructed to chew their gum for a period of 30 min. After induction of anesthesia and tracheal intubation, the stomach was suctioned with a salem sump orogastric tube. We found that children who did not chew gum had significantly smaller GFV as compared with children who chewed sugared and sugarless gum (0.35 [0.20.5] mL/kg versus 0.88 [0.61.4] mL/kg versus 0.69 [0.41.6] mL/kg; P = 0.0001). Children who did not chew gum also had a significantly lower gastric fluid pH as compared with children chewing sugared and sugarless gum (geometric mean, 1.91 versus 2.25 versus 2.19; P = 0.007). We conclude that children who present for surgery while chewing gum have significantly larger GFV and higher pH.
FWIW, if chewing gum raises pH (according to this study), and we give bicitra to raise pH in preggos, what's the difference? harm? i had this same discussion with an attending the other day, and we both came to the same result that we would not delay case for such an example.
I would tell them to spit it out and do exactly what I would have done if they were not chewing gum.
In summary, gum chewing in the holding area, no matter how you slice it, is bad. It's at least a "clear", as it starts the cephalic phase of the digestive cascade.
I wait two hours, and preferably give them a small amount of water (which will dilute the gastric contents and also facilitate gastric emptying). The clock starts when they spit the gum out. I don't see a big need for adjuvant drugs, unless the patient has gastroparesis, concomitant GERD, or some-such.
Can't wait? RSI.
-copro
Bumping an old topic...
Would anybody treat the patient differently if they were chewing gum in preop holding prior to a TEE/CV?