WHY ARE WE NOT ALLOWED TO EAT OR DRINK BEFORE GENERAL ANAESTHESIA?
NOTHING BY MOUTH AFTER MIDNIGHT
Unreasonable request?
What is the reason for this ‘unreasonable’ request you might ask? This is especially true for children, who simply do not understand why they are not allowed to eat or drink anything before elective surgery. What about babies who must be fed at certain times?
We all know what happens when a baby is hungry, they announce it loud and clearly and nothing will comfort them. How can a mother withhold food from her children if they are hungry? I often saw the agony and sometimes tears of helplessness in those parents trying to comfort their children.
ROMANS and GREEKS
During the time of Nero (AD 37 – 68) Roman and Greek Surgeons gave their patients a mixture of wine and vinegar, called a “potion of the condemned”. It was used to relieve anguish during crucifixion.
ARABS and EGYPTIANS
The Arabs and Egyptians were the first to use sleep-producing inhalants. Many potions were concocted from plants such as hemlock and poppy, sponges were saturated in these solutions and held to the patients nostrils. Root juices was used as recovering agents, but death often resulted from them because of unregulated dosages and unknown drug action!
ANESTHESIA NOW
Modern day anesthesia involves the administration of potentially lethal drugs and gasses. Anesthesia is produced as the Central Nervous System (CNS) is affected and results in an unconscious, immobile, quiet patient who does not recall the surgical procedure. The result of anesthetic drugs is one of gradual decrease (depression) of the CNS, beginning with the higher centers of the cerebral cortex and ending with the vital center in the Medulla Oblongata. The anesthesia state encompasses control of sensory, motor, mental and reflex functions. Specific drugs are used to achieve the desired outcome: muscle relaxation, amnesia and analgesia. All protective airway reflexes are lost.
Vomiting or regurgitation may occur when the patient comes to the operating room with a full stomach. Aspiration is a hazard. If the patient aspirate (inhale) vomitus, an asthma-like attack with severe bronchial spasms and wheezing is triggered. The patient can develop aspiration pneumonia, pneumonitis and pulmonary edema, which leads to extreme hypoxia. Brain damage from hypoxia occurs within minutes.
Source: Berry & Kohn's Operating Room Technique 10th edition
CHANGE IN MEDICAL THINKING
Evidence-based medicine is now the standard. In 1999, the Society of Anesthesiology amend its practice guidelines to permit clear liquids, a light or regular meal much closer to the expected time of surgery, than the random advice to eat or drink nothing after 22H00, regardless of their time of surgery. Patients had fasted for an average of 12 to 14 hours in particular and some for as long as 20 hours. Fasting patients suffer from dehydration, headaches, low blood sugar. Some fail to take crucial medications the day of surgery because they had been told nothing by mouth after 22H00.
REVISED GUIDELINES
The anesthesia society permits clear fluids like water, clear apple juice, black tea, two hours before scheduled surgery, breast milk 4 hours before, infant formula and regular milk or a light meal like toast and clear liquids, six hours before and a regular or heavy meal, eight hours before surgery.
OLD HABITS DIE HARD
Most people having elective surgery are still told not to eat or drink after 22H00 the day before surgery. Is this still based on tradition or fear, or is this doctrine held as an established opinion? Medicine has changed significantly over the past years.
Some anesthetist belief that longer fasting is better, for some it is difficult to give each individual different fasting instructions, because of changes in operating schedules, prolonged unplanned surgical cases, the exaggerated concern about aspiration and the lack of concern about the unfavorable effects of fasting or the fear of legal action.
Very informative post @frieda. Something must've happened that made you write this. I'd love to see a post on what happened.
A wise man learns from another man's mistakes but a fool will learn from his own.
I will indeed write about my personal experience regarding above information!
that first baby is SUPER scary
They scare the hell out of me when they cry and nothing you do can stop them!
just image the cry on this one
Interesting informations, Thanks !
Aspiration pneumonia is a bitch. Small risk, but at least in the USSA where we have muli-million dollar lawsuits for much less.......the recommendation will continue.
It is not always the eating before selective surgery, the real problem is that some parents and patients suddenly became strangers to the truth and do not tell the anaethetist that the baby had a bottle of milk or the patient ate a full breakfast, they simply say they did not eat anything since the previous night and you do believe them. If the anaethetists are aware that the patients have eaten, they can post-pone the case for a couple of hours. It will give the anaethetist the opportunity to take the necessary precautions to protect the pt's airways when intubation takes place.
Informative, thank you. Always seemed to have wondered about that ;)
I found that it is safer not to give patients too much information of when and what to eat or drink. There is always someone who will misunderstand what and when to eat. Like the gentleman who ate a biscuit with coffee and milk before his operation, " it is only one biscuit and you said I can have coffee!" He forgets that he was told to have black coffee and toast four hours before his procedure and not one hour before. That "only one biscuit and coffee" could cost him his life!