Authors (including presenting author) :
Chu MHM(1),Yuen TKW(1), Wong JCM(1)
Affiliation :
(1)Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital
Introduction :
Fasting is essential prior to anaesthesia for preventing pulmonary aspiration. ASA recommends fasting of 8 hours after fatty meal, 6 hours after light meal and 2 hours after clear fluids before general anaesthesia, regional anaesthesia and procedural sedation. However, prolonged fasting is often observed and has been studied internationally. Evidence showed prolonged fasting induced insulin resistance, gluconeogenesis, protein depletion and dehydration which can be detrimental to surgical outcome and lengthen hospital stay. In the era of ERAS (Enhanced Recovery After Surgery), prolonged fasting is not recommended.
Objectives :
To assess the fasting time for our patients scheduled for elective surgeries in HKEC.
Methodology :
Quantitative cross-sectional study was conducted in main OTs in the three hospitals in HKEC from the 27th November to 22nd December, 2017. Elective cases were included. Cases done outside main OTs, non-communicable patients and patients under 18 were all excluded. Fasting time was defined as the time between last food or drinks and the time for surgical time-out in OT. Surgical discipline, patients’ demographics including ASA score, whether patients were seen in PAS and if the list was designated as “am” or “pm” list were recorded.
Result & Outcome :
Four-hundred and seventy-eight completed audit forms were collected. The overall mean fasting time for solid food and fluids were 14.03 and 8.85 hours respectively, which were significantly longer than the recommended time (p-value < 0.001, one-sided t test). 4.8% of patients had fasted >20 hours for solid food and 38.9% >10 hours for fluids. The mean time in PYNEH and RH were similar (14.37 vs 14.11 hours, p-value > 0.05, Mann-Whitney U test) while it was significantly shorter in TWEH (8.79 hours, p-value <0.001, Mann-Whitney U test). Significant prolonged fasting was observed in HKEC. We recommend taking this situation seriously while knowing the potential detrimental impact on outcome. Good communication between different parties and early OT list arrangements were recommended. Medical staff should be aware if the patient is scheduled on designated “pm” lists. “Fast after midnight” might not be suitable for everyone and light breakfast can be considered in certain cases. Supper and fluid intake can be encouraged to avoid unnecessary fasting. Carbohydrates drinks could be an option in future as a balance between facilitating OT logistics and improving patients’ nutritional conditions perioperatively.
Co-location with:
