#35875 Perioperative fluid fasting in elective upper limb surgery in a tretiary orthopaedic hospital

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Background and Aims

Fasting guidelines have been established to reduce the risk of a pulmonary aspiration event in patients undergoing anaesthesia. Excessive fasting can contribute to anxiety, nausea, dehydration and physiological derangement. In practice, patients are likely to be fasted for longer than the conventional times. The aim of our project was to identify the average length of fluid fast in our elective patients.

Methods

This was a retrospective case-note review of 50 patients undergoing elective upper limb surgery in our tertiary orthopaedic institution. Their reported fasting times for solids and liquids were recorded. Their sent for operation times were interrogated from Operating Room Management Information System (ORMIS) computer system. This information was subsequently compiled into a datasheet.

Results

The average fasting time for solids was 14h 30mins. The average conventional fluid fasting time was 3h 29 mins. When this adjusted to a sent for operating time, the average time was 6 h 11min (range 0min to 18h 10 min). 16% of patients included in the study were fluid fasted for greater than 12 hours.

Conclusions

Our study revealed excessive fasting times in the majority of our patients. Evidently a two-hour fluid fasting target becomes a longer fast in the real world. We have adapted out current fasting guidelines to align with progressive institutions which use a sip-till-send approach to allow 170ml of water each hour until sent for operating (Checketts 2023). We will re-audit these times after implementation of the guideline.