Gum Chewing

[quark]

How long do you wait before an elective GA case?

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[Bertelman]

I let 'em chew it into the OR. As a matter of fact, I use it to secure the ETT.

 

[Planktonmd]

How long do you wait before an elective GA case?

Why do you have to wait?

 

[pgg]

How long do you wait before an elective GA case?

Did he bring enough for everybody?

 

[Jeff05]

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

 

[Chrysanthemum]

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

Gotta make sure its sugarless!

 

[radslooking]

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.

 

[Planktonmd]

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.

 

[jetproppilot]

And that's why these people work at a plastic surgeon's office and they should not work anywhere else.

 

[Intubate]

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

This is about the only study that shows no difference. Every other one, and there are lots, show significant differences in acidity and/or volume and conclude (right or wrong) that chewing gum should at least be considered a clear. That literature will be used against you in court. Two hours.

 

[Tenesma]

the ONE time during residency when I ran into this...

young guy scheduled for cystoscope w/ TURB... healthy as can be...

chewing gum - i have him spit it out --- attending and I didn't think anything of it.

do an LMA ...

15 minnutes later the LMA is filled with gastric contents and so are his lungs...

hmmm....

 

[radslooking]

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.

sorry, i should have clarified. I can't say for sure they "won't take them" or if they just make them wait a couple of hours, as a previous poster said. But they won't do them immediately.

 

[BLADEMDA]

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 of

Anesthesiology,

Pediatrics, and

Child 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, 5–17 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 [0.2–0.5] mL/kg versus 0.88 [0.6–1.4] mL/kg versus 0.69 [0.4–1.6] 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.

 

[BLADEMDA]

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.

 

[Bertelman]

I was totally thinking of this thread yesterday when I saw a lady before a lumbar lami. We were about to head back to the room, when I noticed she seemed to be chewing some gum. Without asking specifically, I reached for a tissue and asked her to please spit out her gum.

She looked up, and said she wasn't chewing any gum. Seemed a little put-off.

Turns out it was her tardive dyskinesia from the psych meds she was on.

 

[coprolalia]

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

 

[TrustMe]

So far when I have come across this the attending has seen them early and given reglan, bicitra and Zantac and they all got a tube. Had it a couple of weeks ago but pt. was scheduled for excision of a large vocal cord lesion with Honsaker jet ventilation. The only cool thing would have been that the ENT could have watched the gastric contents pass the cords through the microscope. We loaded the guy up with previously stated meds and moved him to the last case of the day.

TM

 

[Arch Guillotti]

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

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?

 

[Intubate]

Yeah, I would delay 2 hours. The one time it happened to me though, it was a 2 year old (who gives their 2 year old gum?) for ear tubes. I walked up to her and said, "Hey are you chewing gum?". She looked at me and swallowed it. That to me becomes food, not a clear. She came back next week.

 

[Planktonmd]

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?

I would tell them to spit it out and do exactly what I would have done if they were not chewing gum.

 

[dfk]

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 of

Anesthesiology,

Pediatrics, and

Child 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, 5–17 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 [0.2–0.5] mL/kg versus 0.88 [0.6–1.4] mL/kg versus 0.69 [0.4–1.6] 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.

 

[coprolalia]

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.

The differences were statistically significant, but the pH was still around 2 in each arm.

In one study I saw (which I can't find right now), the mean pH after famotidine and metoclopramide was around 5.4 or something. That is clinically significant. But, they had to wait two hours (or, at least, that was the study design) to detect the changes.

So, the difference between statistical significance and clinical relevance is an important one, and one a lot of people forget to consider. 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

 

[Consigliere]

If they were chewing gum I would then ask: "did you bring enough for everyone?" If the answer was "no", then I would cancel the surgery.

 

[Arch Guillotti]

I would tell them to spit it out and do exactly what I would have done if they were not chewing gum.

me too

 

[Arch Guillotti]

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

I think you will change your thinking next year.

 

[sethco]

Bumping an old topic...

Would anybody treat the patient differently if they were chewing gum in preop holding prior to a TEE/CV?

 

[fakin' the funk]

Bumping an old topic...

Would anybody treat the patient differently if they were chewing gum in preop holding prior to a TEE/CV?

Yep. 2 hours. Clear.