Adherence to recommendations of preoperative fasting in elective surgery patients in a lithuanian tertiary center

Abstract

Background and Goal of Study: Current fasting guidelines state that no clear liquids should be consumed <2h, solid food <6h before surgery [1]. Objective: The aim of the study was to evaluate the situation in Lithuanian University of Health Sciences Hospital Kaunas Clinics (KC) in terms of awareness, real-time intake and possible adverse symptoms of dehydration. Materials and Methods: The study received ethical approval (No 2023-BEC2-263) and was performed at KC in 11.2023 – 10.2024. Adult consecutive Lithuanian speaking, mentally healthy, admitted for elective surgery patients were asked to fill a survey. Statistical analysis was performed with SPSS 29.0.0.0. Results: Sample included 87 patients, 36 males, 51 females. Mean time of last intake before surgery: 10.82±5.72 h for fluids, 16.16±4.39 h for solid food. According to patients, fluids must not be taken preoperatively: <2h in 16(18.4%), <6h in 51(58.6%), <24h in 16(18.4%) and indefinitely in 4(4.6%) cases. 65(74.7%) patients reported knowing the definition of clear fluids, meanwhile 42(48.3%) marked the correct list of clear fluids. 79(90.8%) patients were informed about preoperative fluid intake: 52 - the surgeon, 35 - a resident doctor, 29 - family doctor or nurse, 23 - an anaesthesiologist, 12 - relied on previous knowledge or social media. Complaints related to prolonged fasting: xerostomia (n=45), thirst (n=43), heart palpitations (n=19), headache (n=11), fatigue (n=7), dizziness (n=5), muscle cramps (n=4), nausea (n=2). Fasting-related adverse effects were arterial hypotension (7 cases, 3 requiring vasopressors), and 1 case of bradycardia. Conclusions: Patient awareness of preoperative fasting is low: 18.4% of respondents define recommended intervals correctly. Mean duration of last oral intake exceeds the recommended interval by 5 times for clear fluids and 2.5 times for solid food. This leads to subjective and objective haemodynamic adverse effects of hypovolaemia.