Preoperative fasting: an online survey in Belgian anesthetists

Abstract

Background: For many decades, preoperative fasting is an established precaution to avoid pulmonary aspiration at induction and emergence from anesthesia. Initially, described by John Snow in 1858, it only became common practice since the 1960’s of the previous century. In recent years, the risks of prolonged preoperative fasting have been described. Patients have a higher chance of discomfort, hypovolemia, ketogenesis and lipolysis. This is especially important in the pediatric population. The European society of anesthesia and intensive care (ESAIC) has updated the preoperative fasting guidelines in 2022 introducing a further liberalization of the preoperative fasting guidelines for the pediatric population. .

Objective: The main objective of this online survey is to establish whether the European society of anesthesia and intensive care guidelines for preoperative fasting are correctly implemented by the anesthetic department in Belgian hospitals.

Methods: An online survey to evaluate the adherence to the fasting guidelines was designed using Qualtrics. The survey was sent to 1437 anesthesiologists with an address, known to the department of anesthesiology UZLeuven, and working in Belgian hospitals during September 7th until November 13th of 2022. The questionnaire contained 29 questions evaluating preoperative fasting guidelines and obstetrics that are used in their respective hospitals and the adherence to the guidelines by themselves (Appendix 1).

Results: The survey was completed by 218 anesthesiologists which is a response rate of 15,17%. Knowledge of the ESAIC guidelines for preoperative fasting was generally adequate to good. However, their local hospital guidelines were commonly not in line with the ESAIC guidelines. Especially the preoperative fasting guidelines for pediatrics and obstetrics were not followed in 68.5% and 61.5% respectively. In general, adherence to guidelines was higher in university teaching centers than in other hospitals.

Conclusion: Despite adequate knowledge of the new guidelines for preoperative fasting, implementation is far from acceptable. Inadequate knowledge of the guidelines by physicians and nursing staff, together with changes in operating room schedule and practical barriers to implement the guidelines are reasons for the slow uptake.