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Research for nursing practice - Pre operative fasting - Literature review Example

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Preoperative fasting Preoperative fasting Preoperative fasting Introduction. Strict fasting regimens had been instituted for the past seventy years prior to elective surgery after Mendelson discovered that pulmonary aspiration was a fatal complication resulting from the intake of food prior to surgery…
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Download file to see previous pages The pathophysiological basis of the aspiration pneumonia was the aspiration of acidic stomach contents into the lungs and the consequent harmful damage to the lung tissues known as chemical pneumonia. As the years went by, the innovative techniques of anaesthesia including the endotracheal intubation led to rethinking on the duration of fasting times. Frequent discussion and research led to the Guidelines from the Royal College of Anaesthetists, the Royal College of Nurses and the Anaesthetists of the US: they stipulated specific periods for fasting for worldwide use (AAGBI, 2001; RCN, 2005; ASA Practice guidelines, 1999). The guidelines sanctioned the shortening of the pre-operative fasting durations but the message was not taken in the right spirit by the nurses and the patients did not enjoy the benefit. The nurses were the ones who instructed the patients about the fasting. Promotion of evidence-based fasting times was to be enforced by them (Crenshaw, 2008). They also had to monitor the patient’s compliance. The scientific evidence related to the liberalized fasting times were to be initially understood by the nurses themselves before efficacious implementation. Research indicated many fallacies in the system whereby fasting practices were still not conforming to the guidelines. Medication instructions also were not accurately transferred to patients (Crenshaw, 2008). Recent researches were moving away from the strict fasting regimen to a partial fasting method whereby a carbohydrate drink or oral carbohydrate nutrients were administered to improve the outcomes of surgery. The nurses were the ones who actually conveyed the right information about the fasting to the patients. The role of the nurses also involved the promoting of evidenced-based guidelines apart from monitoring the patients to check for compliance and untoward effects (Crenshaw and Winslow, 2006).This paper will be written with the intention of unearthing evidence suitable to provide more alterations in the implementation of pre-operative fasting or partial fasting to conform to the evidence-based guidelines. The aim of this research will be to search for methods that could ensure that the elective surgery patients had the benefit of shorter pre-operative fasting times as per guidelines and the improved outcomes of having the pre-carbohydrate drink and how the nurses were to be encouraged to conscientiously perform their work where the pre-operative fasting was concerned. Review of RCTs Brady et al (2003) studied 22 randomised control trials or quasi RCTs. Healthy patients were included as the controls. Permitted intake of food was a small breakfast in the morning before surgery posted for the afternoon. Liquid intake was limited to not more than 30 ml. to help swallow medicine. Methodological quality was maintained by the randomisation method. “Allocation concealment, blinding, a prior sample size calculation, and whether analysis was by intention to treat” were additional methods of maintaining quality (Brady et al, 2003). Regurgitation and aspiration were complications just after the surgery and death was a possibility in many trials. The review of the research articles revealed some limitations. The RCTs were mostly small sampled trials with less than 100 patients. The quality of methodology was inadequate in some trials. The variety in the populations too was minimal and the samples were ...Download file to see next pagesRead More
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