Can fasting instructions before transcatheter aortic valve replacement (TAVR), ablation and other cardiac procedures be relaxed? A team of researchers aimed to find out, presenting its findings in Perioperative Medicine.[1]
Fasting before major operations has been common in healthcare for nearly 80 years, the group explained, but that has started to change since the turn of the century. In fact, the American Society of Anesthesiologists (ASA) recently recommended allowing clear liquids up to two hours before anesthesia for healthy patients undergoing elective procedures, but that decision left healthcare providers with some important questions.
“First, as suggested by the ASA guidelines, much of prior work has focused on ‘healthy’ patients, and many patients undergoing cardiac and other complex procedures do not fit into this category,” wrote lead author Derek Atkinson, MD, an assistant professor in the Renaissance School of Medicine at Stony Brook University in New York, and colleagues. “Second, and perhaps more importantly, previous studies have mostly prescribed fluid, usually a carbohydrate beverage, to patients in the reduced fasting arms, rather than allowed patients to drink clear liquids as they wished, i.e. ad libitum.”
To track the impact of not requiring patients to fast before a percutaneous cardiac procedure, Atkinson et al. tracked data from 181 patients who underwent TAVR or an arrhythmia ablation from September 2019 to July 2021. Patients in the randomized controlled trial were placed into one of two groups. While one group of 91 patients followed traditional orders to fast completely after midnight prior to the operation (the normal care groups), another group of 90 patients was told they could drink unlimited clear liquids up to two hours prior to the operation (the ad libitum group).
“Patients received their instructions at the time of randomization at the pre-operative visit and received a follow-up phone call which reinforced these instructions the day before the procedure,” the authors wrote. “All other nursing, anesthesia and surgical care was routine throughout the pre, intra and post-operative periods.”
Patient characteristics, including age, sex, race and co-morbidities, were similar between the two groups. One exception was the fact that patients in the ad libitum group were more likely to present with a history of post-operative nausea and vomiting.
Overall, surveys answered by each participant revealed that patient satisfaction was not statistically different between the two groups when it came to overall satisfaction, thirst, hunger, headache, nausea, lightheadedness or anxiousness.
No adverse events or case delays were associated with the intervention. Hospital length of stay was also not affected.
“This is significant as case delays can have consequences on operating room efficiency and economics,” the authors wrote.
The team did note that some patients in the ad libitum group still chose not to drink clear liquids after midnight on the day before their heart procedure. Going forward, Atkinson and colleagues suggested that researchers performing similar studies may want to make it a requirement, rather than an option, to drink clear liquids up to two hours prior to their operation.
Read the full analysis here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.