Preoperative Fasting Practices Across Three Anesthesia Societies: Survey of Practitioners

Richard Neville Merchant; Navraj Chima; Olle Ljungqvist; Juliana Nai Jia Kok

doi:10.2196/15905

Preoperative Fasting Practices Across Three Anesthesia Societies: Survey of Practitioners

JMIR Perioper Med. 2020 Jan 28;3(1):e15905. doi: 10.2196/15905.

Authors

Richard Neville Merchant^#¹, Navraj Chima^#², Olle Ljungqvist^#³, Juliana Nai Jia Kok^#⁴

Affiliations

¹ Department of Anesthesiology and Perioperative Medicine, Royal Columbian Hospital, Fraser Health Authority, University of British Columbia, New Westminster, BC, Canada.
² Vancouver Coastal Health Authority, University of British Columbia, Vancouver, BC, Canada.
³ Department of Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden.
⁴ Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia.

^# Contributed equally.

PMID: 33393934
PMCID: PMC7709845
DOI: 10.2196/15905

Abstract

Background: Pulmonary aspiration of gastric contents is recognized as a complication of anesthesia. To minimize that risk, anesthesiologists advised fasting for solid foods and liquids for an often prolonged period of time. However, 30 years ago, evidence was promulgated that fasting for clear liquids was unnecessary to ensure an empty stomach. Despite a strong evidence base and the knowledge that fasting may be physiologically harmful and unpleasant for patients, the adoption of society guidelines recommending short fasting periods for clear fluids into clinical practice is uncertain.

Objective: This study aimed to determine the current practices of anesthetists with respect to fasting guidelines.

Methods: An electronic internet survey was distributed to anesthetists in Canada (CAN), Australia and New Zealand (ANZ), and Europe (EUR) during April 2014 to February 2015. The anesthetists were asked about fasting guidelines, their recommendations to patients for the consumption of clear fluids and solid foods, and the reasons and consequences if these guidelines were not followed.

Results: A total of 971 anesthetists completed the survey (CAN, n=679; ANZ, n=185; and EUR, n=107). Although 85.0% (818/962) of these participants claimed that their advice to patients followed current society guidelines, approximately 50.4% (476/945) enforced strict fasting and did not allow clear fluids after midnight. The primary reasons given were with regard to problems with a variable operating room schedule (255/476, 53.6%) and safety issues surrounding the implementation of clear fluid drinking guidelines (182/476, 38.2%).

Conclusions: Many anesthetists continue to follow outdated practices. The current interest in further liberalizing preoperative fluid intake will require more change in anesthesia culture.

Keywords: guideline adherence; practice guideline; preoperative care.

©Richard Neville Merchant, Navraj Chima, Olle Ljungqvist, Juliana Nai Jia Kok. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 28.01.2020.