The pre-op diet - does it matter?

[seewell]

Did anyone read this article in Anesthesiology?

Proponents of liberalized fasting guidelines.
by Cook-Sather SD, Nicolson SC, Schreiner MS, Maxwell LG, Park JJ, Gallagher PR, Cohen DE
Anesthesiology 2005 Jan;102(1):236-7; author reply 238

I'd love to hear your thoughts.

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[militarymd]

Current NPO guidlines are nothing more than a medical-legal document. There is very poor data on when the stomach is empty, and when gastric contents will lead to aspiration.

I advocate CT scan or ultrasound to evaluate for gastric emptying.

 

[Noyac]

I read it and all I remember is thinking how confused the patients and nurses (our pre-op nurses give the NPO instructions the day b/4 surgery) will be if we allow them to eat some things and not others. I tried to allow oral intake with my patients but it just confuses them and the nurses so much that I have gone back to nothing after midnight. The pts always went too far. Or they thought it was just a form of torture and that it didn't really matter if they ate a Big Mac on the way to the hosp. I frequently would say, well lets just do the case and my partners would say not for 6 hours and others would cancel. The surgeons were confused, the patients were confused and the nurses. It ended up being the most common reason to be called to the per-op clininc. Its just not worth it. If you ask me our society could skip a few more meals as well. I don't remember the study per-se but I think this covers what I got out of it.

 

[seewell]

I read it and all I remember is thinking how confused the patients and nurses QUOTE]

Yes, I agree... The article came onto my radar after reading a similar review at an on-line journal club
http://journalreview.org/view_pubmed_article.php?pmid=15618812&specialty_id=2

"There is fact... there is science... there is theory... and there are lawyers. Is anyone willing to take this chance even if science supports it??"

I was thinking of posting a review too.. but wanted to get some feedback first. Thanks!

 

[adleyinga]

I read it and all I remember is thinking how confused the patients and nurses QUOTE]

Yes, I agree... The article came onto my radar after reading a similar review at an on-line journal club
http://journalreview.org/view_pubmed_article.php?pmid=15618812&specialty_id=2

"There is fact... there is science... there is theory... and there are lawyers. Is anyone willing to take this chance even if science supports it??"

I was thinking of posting a review too.. but wanted to get some feedback first. Thanks!

Yes- I am willing to take the risk. Many years ago in British study was shown that light meal may be better than NPO for 8 hrs. A clear liquids clear in minutes not hrs. That is known from 1800's. In children we only wait 2 -3 hrs for clear liquids and they are a more risk for aspiration than adults-(in gneral) .
So for inteliigent pt I will accept 2 hrs for clear liquids but where I work the rule is MN because people are too stupid to differentiate between apple juice and a BIg MAC ( supersized of course)

 

[jetproppilot]

Yes- I am willing to take the risk. Many years ago in British study was shown that light meal may be better than NPO for 8 hrs. A clear liquids clear in minutes not hrs. That is known from 1800's. In children we only wait 2 -3 hrs for clear liquids and they are a more risk for aspiration than adults-(in gneral) .
So for inteliigent pt I will accept 2 hrs for clear liquids but where I work the rule is MN because people are too stupid to differentiate between apple juice and a BIg MAC ( supersized of course)

The Brits have it all figured out. Heck, their attendings even have a beer with lunch.

But then again they dont have sleezy personal injury lawyers filing incessant frivolous lawsuits.

 

[toughlife]

The Brits have it all figured out. Heck, their attendings even have a beer with lunch.

But then again they dont have sleezy personal injury lawyers filing incessant frivolous lawsuits.

I agree. Lawyers are destroying this great nation of ours.