There was no evidence to suggest a shortened fluid fast results in an increased risk of aspiration, regurgitation or related morbidity compared with the standard 'nil by mouth from midnight' fasting policy. Permitting patients to drink water preoperatively resulted in significantly lower gastric volumes. Clinicians should be encouraged to appraise this evidence for themselves and when necessary adjust any remaining standard fasting policies (nil-by-mouth from midnight) for patients that are not considered 'at-risk' during anaesthesia.
Effect of preoperative oral fluids on gastric volume and pH in postpartum patients.
The effect of preoperative oral fluids to postpartum patients on the gastric volume and pH was compared with normally fasting postpartum and non-pregnant patients undergoing sterilisation. Forty consecutive postpartum patients and twenty non-pregnant patients scheduled for sterilisation procedure were selected for the study. All patients were fasted overnight. Twenty postpartum patients were randomly allocated to receive 150 ml of plain water two and half hours before surgery (Group 1), while the remaining postpartum patients (Group 2) and non-pregnant patients (Group 3) continued their overnight fast as usual. After induction of anesthesia, gastric volume and pH was measured in all the patients. The mean gastric volume was found to be 21.9 +/- 8.49 ml in Group 1, 22.55 +/- 8.30 ml in Group 2 and 22.65 +/- 8.17 ml in Group 3. The mean pH was found to be 2.21 +/- 0.98 in Group 1, 2.18 +/- 0.88 in Group 2 and 2.12 +/- 1.02 in Group 3. The difference in the volume and pH in all the three groups was statistically insignificant. The difference in the incidence of patients with combined high risk factors of acid aspiration syndrome (gastric fluid volume > 25 ml and pH < 2.5) among the three groups was also insignificant. The authors conclude that ingestion of 150 ml of plain water approximately two and half hours before scheduled time of surgery in overnight fasted postpartum patients does not increase the risk of aspiration syndrome.