Despite evidence supporting shorter pre-operative fasting times, actual clinical practice shows excessively long fasting periods and frequent omission of regular medications, including cardiac drugs.
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Excessive fasting and omitted cardiac meds persist in practice; hypothesis-generating for interventions aligning care with shorter-fasting evidence.
Several studies have demonstrated that pre-operative fasting may be as short as 2 h for clear fluids and 6 h for solids with no adverse effect on volume or pH of gastric contents. Other studies suggest that many patients do not receive pre-operative prescribed medications. One hundred and fifty-three adults presenting for elective surgery (mean age 51 years) were studied to assess fasting practice. Fasting times far in excess of the recommended safe minimum were found. Mean length of fast for solids was 15 h 24 min (95% confidence intervals±49 min) and for fluids 12 h 30 min (95% confidence intervals±30 min). Of the 53 patients taking regular medications, 23 did not receive one or more drugs pre-operatively; most notably 45% of cardiac prescriptions were not administered. Despite strong evidence to support a change, actual practice continues to fall below accepted standards.
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Pearse et al. (1999) studied this question.
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