Yurashevich Mary, Chow Adrian, Kowalczyk John J, Traynor Andrea J, Carvalho Brendan
Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Eastern Virginia Medical School, Norfolk, VA, USA.
Turk J Anaesthesiol Reanim. 2019 Aug;47(4):282-286. doi: 10.5152/TJAR.2019.95770. Epub 2019 Mar 12.
Prolonged preoperative fasting may lead to dehydration, hypoglycaemia, ketoacidosis and delayed recovery. We hypothesised that a patient educational initiative would decrease our preoperative fasting periods for elective caesarean delivery.
This was an observational quality improvement impact study. Elective caesarean patients who delivered during our study period were included in the study, 40 patients in the pre-intervention and 40 patients in the post-intervention groups. Only English-speaking patients were included. We developed a patient educational pamphlet outlining preoperative fasting and analgesic expectations for caesarean delivery that was given to every patient at her preoperative anaesthesia consultation. The pamphlet included the American Society of Anesthesiologists' preoperative fasting and enhanced recovery carbohydrate drink recommendations. The primary outcome measure was intended fasting duration for liquids (defined as time from last reported liquid consumption to scheduled caesarean delivery) before and after the patient educational initiative. Secondary outcomes included solid fasting time, types of liquids and solids consumed.
The intended median (interquartile range) fasting time for liquids decreased from 10 (8.9-12) h to 3.5 (2.5-10) h (p<0.001). The fasting period for solids was not significantly different: 12.5 (10.5-14) h pre- versus 12.4 (10.6-14) h post-pamphlet introduction (p=0.384). Despite the recommendation, only 22.5% consumed a carbohydrate-containing drink with a modest decrease in water consumption (87.5% before and 67.5% after; p=0.009).
A patient educational pamphlet significantly reduced fasting time for clear liquids. Future studies are needed to determine what barriers limited adherence to the recommended carbohydrate-containing drink consumption.
术前长时间禁食可能导致脱水、低血糖、酮症酸中毒及恢复延迟。我们推测，一项患者教育举措将缩短择期剖宫产的术前禁食时间。
这是一项观察性质量改进影响研究。研究纳入了在我们研究期间行择期剖宫产的患者，干预前组40例患者，干预后组40例患者。仅纳入说英语的患者。我们编写了一份患者教育手册，概述剖宫产术前禁食及镇痛期望，并在患者术前麻醉咨询时发给每位患者。该手册纳入了美国麻醉医师协会的术前禁食及强化康复碳水化合物饮料建议。主要结局指标为患者教育举措前后预期的液体禁食时长（定义为最后一次报告饮用液体至预定剖宫产的时间）。次要结局包括固体食物禁食时间、摄入的液体及固体食物种类。
预期的液体禁食时间中位数（四分位间距）从10（8.9 - 12）小时降至3.5（2.5 - 10）小时（p<0.001）。固体食物禁食期无显著差异：手册发放前为12.5（10.5 - 14）小时，发放后为12.4（10.6 - 14）小时（p = 0.384）。尽管有此建议，但只有22.5%的患者饮用了含碳水化合物的饮料，饮水量略有下降（之前为87.5%，之后为67.5%；p = 0.009）。
一份患者教育手册显著缩短了清液的禁食时间。未来需要开展研究，以确定哪些障碍限制了对推荐的含碳水化合物饮料摄入的依从性。
