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Chang K, Matthews A, Alexandre S, Vizza J, Conway A. Design Specifications for an Automated System to Deliver Instructions About Preprocedure Fasting. J Perianesth Nurs 2024:S1089-9472(24)00047-9. [PMID: 38819359 DOI: 10.1016/j.jopan.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Many patients undergoing surgical and other medical procedures requiring sedation or anesthesia receive standardized "no eating or drinking after midnight" instructions. This "standardized" instruction does not change regardless of potential alterations in scheduling that result in significant delays in procedure start times. As a result, the duration of preprocedure fasting often far exceeds recommended requirements. A technological solution that automates the delivery of preprocedure fasting instructions to patients would likely improve the patient experience. The purpose of this study was to determine design specifications for the delivery of notifications to patients as part of an automated system. DESIGN A qualitative study was conducted with 14 adult participants using the persona-scenario method. METHODS Participants worked in groups to create realistic but fictitious personas and scenarios that described how individuals like themselves would interact with an automated preprocedure fasting instruction system. Data generated through the development of the scenarios were analyzed to first identify important themes, which were then interpreted into design specifications. FINDINGS Seven women and seven men, aged 25 to 75, developed 9 persona-scenarios, which captured outpatient and inpatient preprocedure fasting experiences, as well as perspectives of individuals who were not comfortable with technology, or those for which English was not the primary spoken language. Most scenarios described preprocedure fasting instructions delivered by an automated bidirectional short message service system. Two major themes were identified as patient priorities, including: (1) enhancing communication between patients and healthcare providers; and (2) the importance of using simple technology so that a greater number of patients with varying degrees of comfort and capabilities would be able to use the system confidently. A corresponding set of proposed design specifications was devised. CONCLUSIONS The results of this study provide actionable ways to operationalize patient-centered ideas in the design of an automated preprocedure fasting instruction system.
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Affiliation(s)
- Kristina Chang
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Amanda Matthews
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Sheryl Alexandre
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Julie Vizza
- Patient Partner Program, University Health Network, Toronto, Ontario, Canada; Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Aaron Conway
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
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Gan H, Liu H, Huang H, He M. Liberal Preoperative Fasting in Adults Undergoing Elective Surgery: A Scoping Review Protocol. Anesthesiol Res Pract 2024; 2024:1519359. [PMID: 38751831 PMCID: PMC11095987 DOI: 10.1155/2024/1519359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/18/2024] Open
Abstract
Background Prolonged fasting before surgery has negative effects on the physiology and psychology of patients. Preoperative liberal fasting proposes that patients can drink clear liquids before entering the operating theater, challenging the guideline strategy of a two-hour preoperative liquid fast for adults. In recent years, there have been an increasing number of studies on liberal preoperative fasting in adults. However, currently there is no consensus on the safe amount of fluid consumed, adverse effects, or benefits of this new policy. Objective This scoping review protocol will map the existing evidence of liberal preoperative fasting in adults undergoing elective surgery for clinical practice, to summarize more scientific evidence to healthcare professionals when providing perioperative care. Methods and Analysis. The methodology will follow the six steps of the Arksey and O'Malley methodological framework and be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. A comprehensive search of six databases will be performed from their inception to 31 May 2023 to identify suitable English studies. Two trained investigators will independently screen and extract the data, and any disagreements will be judged by a third investigator. The results of the study will be presented as graphs or tables. Ethics and Dissemination. This scoping review only examines literature in the database, without reference to human or animal studies, and therefore does not require ethical approval. The findings of this scoping review will be published in peer-reviewed journals or presented at conferences. The Registration Number. This scoping review has been registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/PMW7C).
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Affiliation(s)
- Haoyue Gan
- School of Nursing, North Sichuan Medical College, Nanchong, Sichuan, China
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Hangcheng Liu
- School of Nursing, North Sichuan Medical College, Nanchong, Sichuan, China
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Huaping Huang
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Mei He
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
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Peng Z, Li XJ, Wang YF, Li ZY, Wang J, Chen CL, Yan HY, Jin W, Lu Y, Zhuang Z, Hang CH, Li W. Gender potentially affects early postoperative hyponatremia in pituitary adenoma: XGBoost-based predictive modeling. Heliyon 2024; 10:e28958. [PMID: 38601655 PMCID: PMC11004583 DOI: 10.1016/j.heliyon.2024.e28958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose The occurrence of hyponatremia is a prevalent complication following transnasal transsphenoidal surgery for pituitary adenoma surgery, which adversely affects patient prognosis, hospitalization duration, and rehospitalization risk. The primary objective of this study is to strengthen the correlation between clinical factors associated with pituitary adenoma and postoperative hyponatremia. Additionally, the study aims to develop a predictive model for postoperative hyponatremia in patients with pituitary adenoma, with the ultimate goal of establishing a basis for reducing the occurrence of postoperative hyponatremia following surgical interventions. Methods The chi-square test or Fisher test was employed for nominal data, while the t-test or Mann-Whitney test was utilized for continuous data analysis. In cases where the data exhibited statistical differences, binary logistic analysis was conducted to examine the risk and protective factors associated with postoperative hyponatremia. XGBoost was employed to construct predictive models for hyponatremia in this study. The patients were partitioned into training and test sets, and the most suitable parameters were determined through five-fold cross-validation and subsequently utilized for training on the training set. The discriminatory capability was assessed on the internal validation set. Results and conclusions Out of the total 280 patients included in this investigation, 82 patients experienced early postoperative hyponatremia. Among these individuals, male gender (P = 0.02, odds ratio = 1.98) was identified as a risk factor for early postoperative hyponatremia, while preoperative chloride levels (P = 0.021, odds ratio = 0.866) and surgery time (P = 0.039, odds ratio = 0.990) were identified as protective factors against postoperative hyponatremia. The XGBoost model exhibited a sensitivity of 94.2%, a specificity of 61.5%, a positive predictive value of 51.6%, a negative predictive value of 96%, and identified male gender, preoperative sodium, and preoperative cortisol as the most significant predictors. Our findings indicate that gender may have influence in the development of early postoperative hyponatremia in patients with pituitary adenomas.
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Affiliation(s)
- Zheng Peng
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
| | - Xiao-Jian Li
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
| | - Yun-feng Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
| | - Zhuo-Yuan Li
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
| | - Jie Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
| | - Chun-Lei Chen
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
| | - Hui-Ying Yan
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
| | - Wei Jin
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
| | - Yue Lu
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
| | - Zong Zhuang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
| | - Chun-Hua Hang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
| | - Wei Li
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Neurosurgical Institute, Nanjing University, China
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Rigo EF, Colet R, Backes GT, Zeni J, Hsu AKW. Validation of a popsicle as a clear fluid to abbreviate preoperative fasting. Clin Nutr ESPEN 2024; 59:154-157. [PMID: 38220369 DOI: 10.1016/j.clnesp.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/15/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS This study is based on the development and validation of a popsicle to reduce preoperative fasting time. METHODS The study was carried out in two stages, pre-clinical and clinical validation. The first stage consisted of producing a water-based, fat-free, high-calorie fruit-flavored popsicle, characterized by proximal composition and sensory analysis. In the second stage, clinical validation was performed in patients aged between 18 and 65 years before elective surgery, evaluating the incidence of aspiration during anesthesia and the patient's experience in relation to hunger, thirst, anxiety and palatability of the popsicle. RESULTS The results of the study showed that the use of popsicle 2 h before the surgical procedure did not cause any adverse reaction in patients and in the anesthetic procedure. Furthermore, the full acceptability of the product by the participants and the control of thirst and satiety during the preoperative period were observed. CONCLUSIONS The present study showed that with the use of popsicles it was possible to reduce safely the preoperative fasting time to up to 2 h before the surgical procedure.
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Affiliation(s)
- Eduardo Fabian Rigo
- Medical School, Universidade Regional Integrada do Alto Uruguai e Missões, URI Erechim, Av. Sete de Setembro, 1621, 99709-910, Erechim, RS, Brazil.
| | - Rosicler Colet
- Department of Food Engineering, Universidade Regional Integrada do Alto Uruguai e Missões, URI Erechim, Av. Sete de Setembro, 1621, 99709-910, Erechim, RS, Brazil.
| | - Geciane Toniazzo Backes
- Department of Food Engineering, Universidade Regional Integrada do Alto Uruguai e Missões, URI Erechim, Av. Sete de Setembro, 1621, 99709-910, Erechim, RS, Brazil.
| | - Jamile Zeni
- Department of Food Engineering, Universidade Regional Integrada do Alto Uruguai e Missões, URI Erechim, Av. Sete de Setembro, 1621, 99709-910, Erechim, RS, Brazil.
| | - André Keng Wei Hsu
- Medical School, Universidade Regional Integrada do Alto Uruguai e Missões, URI Erechim, Av. Sete de Setembro, 1621, 99709-910, Erechim, RS, Brazil.
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Bologheanu R, Schaubmayr W, Kimberger O, Duma A. Ultrasound evaluation of gastric emptying time of standardized high-calorie liquid meals in healthy adults: A double-blind cross-over randomized study. Clin Nutr ESPEN 2024; 59:264-269. [PMID: 38220385 DOI: 10.1016/j.clnesp.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND AND AIMS Commercially available high-calorie drinks containing fat and protein can be used as dietary supplements in surgical patients. According to preoperative fasting guidelines, high-calorie drinks are non-clear fluids and should not be consumed 6 h before elective procedures. The aim of this study was to evaluate the gastric emptying time of commercially available high-calorie drink formulations in healthy adults using gastric ultrasound. METHODS 25 healthy adult volunteers were included in this double-blind, cross-over prospective study. On three study sessions, fasted volunteers ingested one of the three study products: a solution of 75 g of glucose in 200 ml of water, a fat-free liquid meal, and a nutritionally complete liquid meal with equal volume and energy content. Gastric ultrasound examinations were performed to evaluate the gastric contents qualitatively and the volume of the gastric contents was calculated from the cross-sectional area of the gastric antrum measured in right lateral position by using a validated model. Repeated gastric ultrasounds were performed at baseline and half-hourly after ingesting the products in supine and right lateral position until the criteria for an empty stomach were met. RESULTS The glucose solution and the standard fat-free high-calorie drink with the same caloric content had a median gastric emptying time of 150 min. The nutritionally complete liquid meal had a median gastric emptying time of 180 min. Gastric emptying was complete in all participants before 6 h had elapsed since ingesting the study products. CONCLUSIONS High calorie liquid meals have a gastric emptying time longer than the recommended fasting time for clear fluids, but shorter than the recommended fasting time for solids in healthy adults.
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Affiliation(s)
| | | | - Oliver Kimberger
- Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Andreas Duma
- Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; University Hospital Tulln, Alter Ziegelweg 10, 3430, Tulln an der Donau, Lower Austria, Austria.
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Xu JB. Correlation between fasting time and bleeding, infection, and perforation after high-frequency electroresection of polyps under colonoscopy. Shijie Huaren Xiaohua Zazhi 2023; 31:973-980. [DOI: 10.11569/wcjd.v31.i23.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/14/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) is a common method for treating colorectal polyps. The duration of fasting after the operation has been the focus of clinical attention. However, there is currently a lack of research on the correlation between fasting duration and the occurrence of bleeding, infection, and perforation.
AIM To explore the relationship between fasting time and bleeding, infection, and perforation after colonoscopic electro-resection of polyps to provide guidance on fasting strategies for postoperative patients.
METHODS In a cohort of 14857 colorectal polyp patients admitted to the Second People's Hospital of Luqiao District from 2000 to 2023, a case-control study design with matching propensity scores was used to evaluate the risk of bleeding and perforation after polypectomy in adults aged 40 years and older; 3505 patients with short-term postoperative fasting and 9669 patients with prolonged postoperative fasting met the study criteria. A total of 2560 patients in each group were matched for further analysis. The postoperative fasting time of the experimental group was 2 h, and the postoperative fasting time of the control group was 24 h. The liquid food was gradually replaced with semi-liquid food and ordinary food according to the size of the incision and the effect of the operation. The postoperative follow-up duration was 1 mo, and the incidence of postoperative bleeding, infection, and perforation in both groups was recorded.
RESULTS In the short fasting group, the rates of bleeding, infection, and perforation were 0.64%, 0.07%, and 0.07%, respectively. In the long fasting group, the rates of bleeding, infection, and perforation were 0.40%, 0.04%, and 0.04%, respectively. There was no significant difference between the two groups in terms of the rates of bleeding, infection, and perforation.
CONCLUSION Based on these results, it can be preliminarily concluded that the duration of postoperative fasting may not have a significant effect on the incidence of bleeding, infection, and perforation after colonoscopic high-frequency electroresection of polyps. For choosing fasting time, strategies can be developed according to the specific situation and actual needs of the patient. However, it is important to note that this is only a retrospective study and more clinical studies are needed to further validate our findings and explore other possible influencing factors.
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Affiliation(s)
- Jun-Bin Xu
- Department of Gastroenterology, The Second People's Hospital of Luqiao District, Taizhou 318058, Zhejiang Province, China
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7
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Barbosa J, Valentim M, Almeida M, Vasconcelos L. The Impact of Fluid Therapy on Glycemic Variation in Non-diabetic Patients Undergoing Laparoscopy. Cureus 2023; 15:e49240. [PMID: 38143600 PMCID: PMC10741234 DOI: 10.7759/cureus.49240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Background Hyperglycemia is a risk factor for perioperative morbidity and mortality. A surgical procedure triggers a physiological stress response, which culminates in insulin resistance by activating the sympathetic autonomic system. The impact of fluid management in the perioperative period on the glycemic variation of patients has not been thoroughly investigated. Methods This study, which included 42 non-diabetic patients undergoing laparoscopic surgeries, was an observational, prospective cohort study. The sample was split into two groups according to the type of fluid used intraoperatively: polyelectrolyte and 5% glucose polyelectrolyte. Results No significant differences were found between the groups in demographic and baseline data, including age, BMI, and American Society of Anesthesiologists (ASA) physical status. There were no differences in glycemic variation between the two groups. Blood glucose varied over time with statistical significance in the perioperative period but with no difference between the two groups. Conclusion Using 5% glucose polyelectrolyte in laparoscopic surgery for non-diabetic patients with ASA physical status 3 or lower did not significantly affect glycemic variation compared to polyelectrolyte. These results suggest the possibility of optimizing resources and minimizing waste without compromising patient homeostasis in perioperative care.
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Affiliation(s)
- João Barbosa
- Anesthesiology Department, Hospital de Braga, Braga, PRT
| | - Maria Valentim
- Anesthesiology Department, Hospital de Braga, Braga, PRT
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Flore G, Deledda A, Fosci M, Lombardo M, Moroni E, Pintus S, Velluzzi F, Fantola G. Perioperative Nutritional Management in Enhanced Recovery after Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6899. [PMID: 37835169 PMCID: PMC10573058 DOI: 10.3390/ijerph20196899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
Obesity is a crucial health problem because it leads to several chronic diseases with an increased risk of mortality and it is very hard to reverse with conventional treatment including changes in lifestyle and pharmacotherapy. Bariatric surgery (BS), comprising a range of various surgical procedures that modify the digestive tract favouring weight loss, is considered the most effective medical intervention to counteract severe obesity, especially in the presence of metabolic comorbidities. The Enhanced Recovery After Bariatric Surgery (ERABS) protocols include a set of recommendations that can be applied before and after BS. The primary aim of ERABS protocols is to facilitate and expedite the recovery process while enhancing the overall effectiveness of bariatric procedures. ERABS protocols include indications about preoperative fasting as well as on how to feed the patient on the day of the intervention, and how to nourish and hydrate in the days after BS. This narrative review examines the application, the feasibility and the efficacy of ERABS protocols applied to the field of nutrition. We found that ERABS protocols, in particular not fasting the patient before the surgery, are often not correctly applied for reasons that are not evidence-based. Furthermore, we identified some gaps in the research about some practises that could be implemented in the presence of additional evidence.
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Affiliation(s)
- Giovanna Flore
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Andrea Deledda
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Michele Fosci
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166 Rome, Italy;
| | - Enrico Moroni
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
| | - Stefano Pintus
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
| | - Fernanda Velluzzi
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Giovanni Fantola
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
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9
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de Klerk ES, de Grunt MN, Hollmann MW, Preckel B, Hermanides J, van Stijn MFM. Incidence of excessive preoperative fasting: a prospective observational study. Br J Anaesth 2023; 130:e440-e442. [PMID: 36670008 DOI: 10.1016/j.bja.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 01/20/2023] Open
Affiliation(s)
- Eline S de Klerk
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Midas N de Grunt
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Benedikt Preckel
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Jeroen Hermanides
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Mireille F M van Stijn
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.
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10
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Beck MH, Balci-Hakimeh D, Scheuerecker F, Wallach C, Güngor HL, Lee M, Abdel-Kawi AF, Glajzer J, Vasiljeva J, Kubiak K, Blohmer JU, Sehouli J, Pietzner K. Real-World Evidence: How Long Do Our Patients Fast?-Results from a Prospective JAGO-NOGGO-Multicenter Analysis on Perioperative Fasting in 924 Patients with Malignant and Benign Gynecological Diseases. Cancers (Basel) 2023; 15:cancers15041311. [PMID: 36831652 PMCID: PMC9953889 DOI: 10.3390/cancers15041311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Despite the key role of optimized fasting in modern perioperative patient management, little current data exist on perioperative fasting intervals in routine clinical practice. METHODS In this multicenter prospective study, the length of pre- and postoperative fasting intervals was assessed with the use of a specifically developed questionnaire. Between 15 January 2021 and 31 May 2022, 924 gynecology patients were included, from 13 German gynecology departments. RESULTS On average, patients remained fasting for about three times as long as recommended for solid foods (17:02 ± 06:54 h) and about five times as long as recommended for clear fluids (9:21 ± 5:48 h). The average perioperative fasting interval exceeded one day (28:23 ± 14:02 h). Longer fasting intervals were observed before and after oncological or extensive procedures, while shorter preoperative fasting intervals were reported in the participating university hospitals. Smoking, treatment in a non-university hospital, an increased Charlson Comorbidity Index and extensive surgery were significant predictors of longer preoperative fasting from solid foods. In general, prolonged preoperative fasting was tolerated well and quality of patient information was perceived as good. CONCLUSION Perioperative fasting intervals were drastically prolonged in this cohort of 924 gynecology patients. Our data indicate the need for better patient education about perioperative fasting.
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Affiliation(s)
- Maximilian Heinz Beck
- Department of Gynecology, Breast Center, Campus Mitte, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117 Berlin, Germany
- Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-564172
| | - Derya Balci-Hakimeh
- Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany
- Department of Gynecology, St. Joseph Hospital, 12101 Berlin, Germany
| | - Florian Scheuerecker
- Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany
- Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Charlotte Wallach
- Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany
- Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Hannah Lena Güngor
- Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany
- Department of Gynecology, Katholisches Marienkrankenhaus—Klinik für Gynäkologie, 22087 Hamburg, Germany
| | - Marlene Lee
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany
| | - Ahmed Farouk Abdel-Kawi
- Department of Gynecology, Katholisches Marienkrankenhaus—Klinik für Gynäkologie, 22087 Hamburg, Germany
- Department of Gynecology, Faculty of Medicine, University of Assiut, Assiut 71515, Egypt
| | - Jacek Glajzer
- Department of Gynecology and Obstetrics, Breast Center Ostsachsen, Klinikum Oberlausitzer Bergland Zittau/Ebersbach, 02730 Ebersbach, Germany
| | | | - Karol Kubiak
- Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany
- Department of Gynecology and Obstetrics, St. Franziskus Hospital Muenster, 48145 Muenster, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology, Breast Center, Campus Mitte, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117 Berlin, Germany
| | - Jalid Sehouli
- Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany
| | - Klaus Pietzner
- Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany
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Liddle C. Preoperative fasting: exploring guidelines and evidence to ensure consistent, high-quality care. Nurs Stand 2022; 37:77-82. [PMID: 36377391 DOI: 10.7748/ns.2022.e12033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/16/2022]
Abstract
Many nurses will still be familiar with the instruction 'nil by mouth from midnight' traditionally given to patients preparing to undergo surgery. National and international guidelines now promote much shorter preoperative fasting times, encapsulated in the '2-4-6 rule' - two hours for clear fluids, four hours for breast milk and six hours for solids. The latest evidence appears to show that these fasting times are in need of revision. Furthermore, there are inconsistencies in how guidelines are implemented. This article explores the guidelines and literature on preoperative fasting in adults and children to determine what the evidence is and what changes could be made to ensure consistent, high-quality patient care.
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van Noort HHJ, Lamers CR, Vermeulen H, Huisman-de Waal G, Witteman BJM. Patient Education Regarding Fasting Recommendations to Shorten Fasting Times in Patients Undergoing Esophagogastroduodenoscopy: A Controlled Pilot Study. Gastroenterol Nurs 2022; 45:342-353. [PMID: 35856722 PMCID: PMC9514738 DOI: 10.1097/sga.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
This study evaluated the applicability and efficacy of patient education regarding fasting recommendations to shorten fasting times in patients undergoing esophagogastroduodenoscopy (EGD). A prospective nonrandomized controlled pilot study was performed. The intervention group (IG) was educated by nurses to eat until 6 hours and drink until 2 hours before EGD. The control group (CG) received usual care. Outcomes were applicability as perceived by patients, adherence to fasting recommendations, gastric visibility, and patients' comfort. A total of 109 patients were included of whom 42 were IG patients (37%). Patients' perspectives on fasting, their experienced discomfort, professional support, and circadian rhythm influenced application of fasting recommendations. Adherence to length of fasting from foods improved with 3:14 hours ( p < .001) and from liquids with 5:22 hours ( p < .001) in the IG compared with the CG. Gastric visibility during EGD was better in the IG than in the CG. The IG patients experienced significant less thirst, hunger, headache, and anxiety. To successfully reduce fasting times, fasting education should include positive, individual instructions, which help patients apply the fasting recommendations within their biorhythm. Positive, concrete instructions by nurses shortened fasting times before EGD, which improved gastric visibility and reduced patient discomfort.
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Affiliation(s)
- Harm H. J. van Noort
- Correspondence to: Harm H. J. van Noort, MSc, RN, Department of Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands ()
| | - Carlijn R. Lamers
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Hester Vermeulen
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Getty Huisman-de Waal
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Ben J. M. Witteman
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Shin HJ, Koo BW, Lim D, Na HS. Ultrasound assessment of gastric volume in older adults after drinking carbohydrate-containing fluids: a prospective, nonrandomized, and noninferiority comparative study. Can J Anaesth 2022; 69:1160-1166. [PMID: 35449247 DOI: 10.1007/s12630-022-02262-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/20/2022] [Accepted: 02/23/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the safety of drinking carbohydrate-containing fluids two hours prior to surgery in older adults using ultrasonography. METHODS We conducted a nonrandomized and noninferiority comparative study in 60 patients aged over 65 yr who were scheduled for total knee arthroplasty. Patients who were fasted from midnight (fasting group) or who drank 400 mL of a carbohydrate-containing fluid (carbohydrate ingestion group) two hours prior to surgery were matched for age, sex, and body mass index. We measured the cross-sectional area (CSA) of gastric antrum using ultrasound and estimated the gastric fluid volume as the study's primary outcome measure. The noninferiority margin (δ) for the mean difference was predefined as 50 mL. The secondary outcome measures included CSA of the antrum and qualitative gastric volume. RESULTS The mean (standard deviation) gastric volume was not significantly different between the fasting group and the carbohydrate ingestion group (30.2 [25.4] mL vs 28.4 [35.8] mL; each group, n = 30; P = 0.81). The mean difference in gastric volume was -1.9 mL (95% confidence interval [CI], -17.9 to 14.2), and the upper limit of the 95% CI was lower than the prespecified noninferiority limit (δ = 50 mL). Secondary outcomes were not significantly different between the two groups. CONCLUSION Drinking of carbohydrate-containing fluid two hours prior to surgery was noninferior to overnight fasting with respect to residual gastric volume at induction of anesthesia in healthy older adults who undergoing total knee arthroplasty. STUDY REGISTRATION ClinicalTrials.gov (NCT04514380); registered 14 August 2020.
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Affiliation(s)
- Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi 173, Bundang, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Bon-Wook Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi 173, Bundang, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Dongsik Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi 173, Bundang, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi 173, Bundang, Seongnam, Gyeonggi, 13620, Republic of Korea.
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