Fasting Times and Increase Carbohydrate Drink Utilization Prior to Cesarean Delivery
Abstract Number: T2B-6
Abstract Type: Original Research
Introduction: Preoperative fasting reduces the risk of pulmonary aspiration and emesis. Prolonged fasting may lead to dehydration, hypoglycemia, ketoacidosis and delayed recovery. (1,2) A previous quality improvement project conducted at our institution found prolonged solid and liquid fasting periods prior to elective cesarean delivery. We hypothesized that after implementation of a patient educational initiative, our preoperative fasting periods for elective cesarean delivery patients would decrease.
Methods: This quality improvement project analysis received IRB exemption. We developed a patient educational pamphlet outlining preoperative fasting and analgesic expectations for cesarean delivery which was given to every patient at her preoperative anesthesia consultation. The pamphlet included American Society of Anesthesiologists' recommendations for fasting guideline (i.e. 2 hours for clear fluids and 8 hours for solids), combined with Enhanced Recovery After Surgery recommendations for carbohydrate drinks up to 2 hours prior to surgery. The primary outcome measures were intended fasting duration for liquids (defined as the time duration between patient last reported liquid consumption and scheduled cesarean delivery time) before and after the patient educational initiative. Secondary outcomes included solid fasting time, and types of liquids and solids consumed.
Results: The intended median [interquartile range] fasting time for liquids decreased from 10 hours [8.9-12] to 3.5 hours [2.5-10] (Fig 1a; p<0.001). The fasting period for solids was not significantly different: 12.5 [10.5-14] vs. 12.4 [10.6-14] pre- and post-pamphlet intervention, respectively (Fig 1b; 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 the intervention; p=0.009).
Conclusion: A patient educational pamphlet significantly reduced fasting time for clear liquids. Further studies are needed to determine what barriers limited adherence to the recommendation to consume a carbohydrate-containing drink, and if reducing fasting duration can improve functional recovery and related side effects after cesarean delivery.
1. Anesthesiology 2015; 123(6): 1455-72.
2. Clinical Nutrition 2012; 31(6): 783-800.