Evidence Based Approach to Preoperative Fasting Time Before Cesarean Section

Year 2018, , 81 - 86, 11.02.2018

Tuba Kızılkaya , Asiye Gül

https://doi.org/10.17681/hsp.332781

Abstract

Evidence-based
practices includes the best interventions for the patients. There are some
evidences and suggestions about preoperative fasting time before cesarean
section. Restricting oral intake of liquids or solids from midnight is an old
practice called nil per os (NPO) is widely practiced in clinics. This is used
to minimize the complications of anesthesia such as aspiration and
regurgitation. When the surgical procedure delayed, fasting period is
prolonged. Prolonged fasting times can cause harm effects like dehydration,
insulin resistance, anxiety and headache. Current preoperative fasting
guidelines and evidence-based practices should be followed to reduce these
undesirable effects. Fasting from the intake of clear liquids for two hours;
solids for six or eight hours before surgery is suggested in the current
guidelines. Health professionals especially midwives who give care for women
before cesarean section, should follow the current guidelines to increase the quality
of healthcare. In this review, the effects of the pre-cesarean fasting period,
current practices and recommendations were discussed in order to increase the
knowledge level of health professionals.

Keywords

fasting, preoperative care, evidence-based practice, cesarean section

Sezaryen Öncesi Açlık Süresinde Kanıta Dayalı Yaklaşım / Evidence Based Approach to Preoperative Fasting Time Before Cesarean Section

Abstract

Kanıta
dayalı uygulamalar klinikte hastalar için en doğru kararı vermede etkili olan
uygulamaları içermektedir. Sezaryen öncesi hazırlık sürecinde açlık süresine
ilişkin kılavuzlarda çeşitli öneriler ve kanıt düzeyleri mevcuttur. Bu süreçte eski
bir uygulama olan nil per os (NPO) yani oral alımın gece yarısından itibaren kısıtlanması
yaygın olarak uygulanır. Bu kısıtlamanın amacı aspirasyon ve regurjitasyon gibi
anesteziye bağlı komplikasyonları en aza indirmektir. Cerrahi işlemin gecikmesi
veya ertelenmesi açlık süresinin daha fazla uzamasına neden olur. Açlık
süresinin uzaması ise dehidratasyon, insulin direnci, kaygı ve baş ağrısı gibi
olumsuz sonuçlara yol açabilir. Bu olumsuz sonuçları en az düzeye indirmek için
cerrahi öncesi açlıkla ilgili güncel kılavuzlar takip edilmelidir. Güncel
kılavuzlarda sezaryen öncesi son iki saate kadar sıvı gıda alımına, son 6-8
saate kadar da katı gıda alımına izin verilmektedir. Ebeler başta olmak üzere
sezaryen öncesi süreçte gebelere bakım veren sağlık profesyonelleri verilen
bakımın kalitesini artırmak için güncel kılavuzları takip etmeli ve önerilere
uygun girişimleri benimsemelidir. Bu derlemede sağlık profesyonellerinin konu
ile ilgili bilgi düzeylerini arttırmak amacıyla sezaryen öncesi açlık süresinin
etkileri, günümüzdeki uygulamalar ve öneriler ele alındı.

Keywords

açlık, ameliyat öncesi bakım, kanıta dayalı uygulama, sezaryen

References

• Chard R. Care of preoperative patients. In: Ignatavicius DD, Workman ML, eds. Medical Surgical Nursing: Patient-Centered Collaborative Care, 7th ed. St. Louis: Saunders Elsevier; 2013. p:239-254.
• WHO Guidelines for safe surgery: Safe surgery saves lives 2009. (Cited: 25.07.2017) Available from: http://apps.who.int/iris/bitstream/10665/44185/1/9789241598552_eng.pdf
• Ljungqvist O. Preoperative fasting and carbohydrate treatment. In: Feldman LS, Delaney CP, Ljungqvist O, Carli F, editors. The SAGES / ERAS® society manual of enhanced recovery programs for gastrointestinal surgery. Switzerland: Springer International Publishing; 2015. p.41.
• Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Obstetrical & Gynecological Survey 1946; 1(6), 837-839.
• Demirdağ H & Karaöz S. Ameliyat öncesi besin/sıvı kısıtlamasına ilişkin hastaların deneyimleri ve hemşirelerin konu ile ilgili bilgi ve uygulamaları [Patients experiences about preoperative fasting and nurses knowledge and practice] Florence Nightingale Hemşirelik Dergisi [Florence Nightingale Journal of Nursing] 2015; 23(1), 1-10.
• Dolgun E, Taşdemir N, Ter N, & Yavuz M. Cerrahi hastalarının ameliyat öncesi aç kalma sürelerinin incelenmesi [Investigation of preoperative fasting times of surgical patients]. Fırat Üniversitesi Sağlık Bilimleri Tıp Dergisi [Fırat University Journal of Health Sciences Medicine] Dergisi 2011; 25 (1): 11-15
• Gül A, Andsoy II, Üstündağ H, Özkaya BÖ. Assessment of preoperative fasting time in elective general surgery. The Journal of Macro Trends in Health and Medicine 2013; 1(1): 1-8.
• Robson EJ., Tanqueray TA, Mackenzie MJ & Yentis SM. The effect of reducing fluid fasting times on thirst and urine osmolality in women undergoing elective caesarean delivery. International Journal of Obstetric Anesthesia, 2013; 22(2), 165-167.
• Jolliffe DM. Practical gastric physiology. Continuing education in anaesthesia, Critical Care & Pain, 2009; 9(6), 173-177.
• Tasch MD and Langeron O. In: Hagberg CA, ed. Aspiration prevention and prophylaxis: preoperative considerations. Benumof And Hagberg's Airway Management, 3rd edition, Philadelphia: Elsevier Saunders; 2013. pp:265-268
• Yıldız H. Preoperatif açlık sürecinde yeni yaklaşımlar. [New approaches during preoperative poverty process] AÜTD [MJAU] 2006; 38, 1-5.
• Canbay Ö, Adar S, Karagöz AH, Çelebi N, & Bilen CY. Effect of preoperative consumption of high carbohydrate drink (Pre-Op®) on postoperative metabolic stress reaction in patients undergoing radical prostatectomy. International Urology and Nephrology 2014; 46(7), 1329- 1333.
• Tauhid-Ul-Mulk M, Rahman SMF, Ali NP, Haque M & Chaudhary MRA. Influence of preoperative fasting time on maternal and neonatal blood glucose level in elective caesarean section under subarachnoid block. Journal of Armed Forces Medical College 2010; 6(2), 21- 24.
• Mackenzie M, Yentis S, Woolnough M and Johnson M. Fasting periods and dehydration before elective caesarean section. Anaesthesia, 2010; 65, 94-113.
• Brady MC, Kinn S, Stuart P, Ness V. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database of Systematic Reviews. 2010; Issue 4. Art. No.: CD004423
• Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2013; 8. Art.No.:CD003930.
• Kurban Y, Uyar İ, Günakan E, & Babayiğit M. Demonstratif bir sezaryen komplikasyonu ve yönetimi: aspirasyon pnömonisi [A demonstrative cesarean complicatıon and management: aspiration pnomonia] Tepecik Eğit Hast Derg [The Journal of Tepecik Education and Research Hospital] 2014; 24 (2): 147 150
• Lesage S. Cesarean delivery under general anesthesia: Continuing Professional Development. Canadian Journal of Anesthesia/Journal Canadien d'anesthésie, 2014; 61(5), 489-503.
• Ersoy E & Gündoğdu H. Preoperatif açlıkta değişen kavramlar [Alternating concepts in preoperative fasting]. Ulusal Cerrahi Dergisi [Turkish Journal of Surgery] Ulusal Cerrahi Dergisi 2005; 21(2), 096-101.
• Yılmaz E & Çöl M. Kanıta dayalı tıp [Evidence based medicine]. Journal of Clinical and Analytical Medicine 2014; 5(6):537-542
• Kocaman G. Hemşirelikte kanıta dayalı uygulama [Evidence-based practice in nursing]. Hemşirelikte Araştırma Geliştirme Dergisi 2003; 2:61-69.
• Açıkel C. Meta-analiz ve kanıta dayalı tıp’taki yeri [Meta-analysis and its place in evidence based medicine]. Bulletin of Clinical Psychopharmacology, 2009; 19:164-172.
• Smith I, Kranke P, Murat I, Smith A, O’Sullivan G, Søreide E, Spies C, Bas in’t Veld B. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol, 2011; 28:556–569.
• American Society of Anesthesiologists Committee (ASA). Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology, 2011;114(3), 495.
• Levy DM. Pre-operative fasting—60 years on from Mendelson. Continuing Education In Anaesthesia, Critical Care & Pain 2006; 6(6), 215-218.
• Lambert E. & Carey S. (2015). Practice guideline recommendations on perioperative fasting a systematic review. Journal Of Parenteral And Enteral Nutrition, 20(10): 1-8.
• American Society of Anesthesiologists Task Force on Obstetric Anesthesia. (2016). Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology 2. Vol.124, 270-300.
• Sandhar B. General considerations. In K. G. Allman, & I. H. Wilson (Eds.), Oxford Handbook of Anaesthesia, 3rd edition, New York: Oxford university press; 2011. p:10
• TARD- Türk Anesteziyoloji ve Reanimasyon Derneği [Turkish Society of Anesthesiology andReanimation] Sezaryen Ameliyatlarında Genel Anestezi Uygulama Kılavuzu 2015. http://www.tard.org.tr/assets/kilavuz/9.pdf (Son erişim tarihi:25.07.2017)
• The Association of Anaesthetists of Great Britain & Ireland and the Obstetric Anaesthetists’ Association (2013). https://www.aagbi.org/sites/default/files/obstetric_anaesthetic_services_2013.pdf (Son erişim tarihi:25.07.2017)
• Imbelloni LE. Pombo IAN & Morais Filho GBD. Reduced fasting time improves comfort and satisfaction of elderly patients undergoing anesthesia for hip fracture. Revista Brasileira De Anestesiologia, 2015; 65(2), 117-123.
• Crenshaw JT. Preoperative fasting: will the evidence ever be put into practice. The American Journal of Nursing, 2011; (10), 38-43.