{"id":97923,"date":"2023-09-18T21:08:40","date_gmt":"2023-09-18T21:08:40","guid":{"rendered":"https:\/\/turbocelebrity.com\/?p=97923"},"modified":"2023-09-18T21:08:40","modified_gmt":"2023-09-18T21:08:40","slug":"a-drink-before-surgery-patients-may-be-fasting-longer-than-needed","status":"publish","type":"post","link":"https:\/\/turbocelebrity.com\/world-news\/a-drink-before-surgery-patients-may-be-fasting-longer-than-needed\/","title":{"rendered":"A drink before surgery? Patients may be fasting longer than needed"},"content":{"rendered":"

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Two Sydney hospitals have become the first in Australia to relax rules for fasting before surgery, as growing evidence shows patients can safely drink water, juice and even black coffee while waiting for a procedure.<\/p>\n

Since July, patients having elective surgery at Prince of Wales Hospital in Randwick and Sydney Eye Hospital have been allowed to drink \u201cclear\u201d liquids \u2013 those without milk or pulp \u2013 right up to going into the operating theatre.<\/p>\n

<\/p>\n

Dr Louisa Lowes says fasting rules for surgery were causing unnecessary discomfort. <\/span>Credit: <\/span>Wolter Peeters<\/cite><\/p>\n

Patients are asked to fast from food and drink as a precaution to reduce the risk of vomiting or asphyxiating during surgery.<\/p>\n

However, growing evidence about how quickly the stomach empties suggests there is little risk from patients having water, refined juice or black coffee and tea before going under anaesthetic.<\/p>\n

The two hospitals join a growing group of more than 170 facilities worldwide which have switched to a \u201csip \u2019til send\u201d model popularised in the UK. In South Australia, Royal Adelaide Hospital has also adopted the policy.<\/p>\n

Anaesthetist Dr Louisa Lowes, Prince of Wales\u2019 director of perioperative medicine and one of three clinicians at the hospital who led the change, said there had been no increase in adverse events since the change in July.<\/p>\n

\u201cOur big concern is that patients waiting for theatre can get quite uncomfortable when they can\u2019t have anything to drink at all,\u201d she said.<\/p>\n

The previous fasting regime also presented a problem when procedures were delayed, Lowes said.<\/p>\n

\u201cStaff will be hesitant to give someone a drink because they don\u2019t know if they will need to be sent in the next two hours, and as a result people have been fasting longer than they need to.\u201d<\/p>\n

Patients may sip on 200 millilitres of a drink, or a small cup, each hour before surgery. Previously, they needed to fast from two hours before surgery. Rules for eating \u2013 banned from six hours before surgery \u2013 remain unchanged.<\/p>\n

The Australia and New Zealand College of Anaesthetists rewrote its elective surgery fasting guidelines in 2022, reducing the recommended fasting time from clear liquids from six hours to two.<\/p>\n

Professor Joanna Sutherland, chair of the college\u2019s safety and quality committee, said evidence was increasingly showing that the old rule of \u201cfasting from midnight\u201d from liquids before a procedure did more harm than good.<\/p>\n

She said liquids not only did not pose the same risk of vomiting or choking \u2013 through airway blockage or inflammation of the lungs from acidic material \u2013 as solids, but likely even helped reduce it.<\/p>\n

\u201cWe now understand the longer a normal stomach is kept empty of clear fluids, the more likely the acidic environment in the stomach could cause damage to the lung,\u201d she said.<\/p>\n

\u201cIf you give a small amount of fluid it will not only dilute the acid but will also encourage the stomach to empty.\u201d<\/p>\n

She said it was possible further changes to the college\u2019s fasting guidelines for clear liquids could occur. However, she said anaesthetists were \u201cvery risk averse\u201d, and there was a need to not over-complicate the message to patients.<\/p>\n

Sutherland said it was important for patients to take their fasting instructions from their own surgical team, noting a variety of medications \u2013 including opioids and appetite suppressant drugs, such as Ozempic \u2013 impact the speed at which the stomach empties.<\/p>\n

In private hospitals, fasting directions are usually determined by individual surgeons.<\/p>\n

Dr Michelle Atkinson, a private orthopaedic surgeon in Sydney and president of the Royal Australasian College of Surgeons, said some surgeons \u2013 including herself \u2013 already allowed patients to drink until surgery, noting papers on its safety had been published since the early 1990s.<\/p>\n

Lowes said she was hopeful more public hospitals would also make the change.<\/p>\n

\u201cThe ball is now rolling: there are a lot of other hospitals that are interested in this, and I think we will see more change their own guidelines and policies moving forwards,\u201d she said.<\/p>\n

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