Ukrainian Journal Health of Woman. 2023. 4(167): 46-51; doi: 10.15574/HW.2023.167.46
Tytarenko N. V., Kostiuchenko A. V., Bevz G. V., Datsiuk O. I., Vozniuk A. V., Zasadnyuk O. P.
National Pirogov Memorial Medical University, Vinnytsia, Ukraine

For citation: Tytarenko NV, Kostiuchenko AV, Bevz GV, Datsiuk OI, Vozniuk AV, Zasadnyuk OP. (2023). Multicenter survey of practicing doctors of the Vinnytsia region regarding compliance with preoperative fasting and aspiration prevention recommendations. Ukrainian Journal Health of Woman. 4(167): 46-51; doi: 10.15574/HW.2023.167.46.
Article received: Jun 11, 2023. Accepted for publication: Sep 10, 2023.

Reducing the period of preoperative fasting is one of the most important principles of rapid metabolic optimization of patients within the concept of enhanced recovery after caesarean section (ERAS).
Purpose – to analyze compliance by anesthesiologists with the recommendations of current protocols regarding preoperative fasting and prevention of aspiration in obstetric hospitals/departments of the city of Vinnytsia and the Vinnytsia region.
Materials and methods. We conducted a multicenter survey in which 70 anesthesiologists from 21 medical institutions of Vinnytsia and Vinnytsia region, which provide assistance to obstetric patients, took part. Statistical data processing was carried out using the SPSS 21 program.
Results. The results of our study show that most respondents (57.1%) recommend pregnant women to stop eating solid food 6-8 hours before cesarean section. It has been found that only 10% of anesthesiologists recommend to stop fluid intake as stated by current guidelines, i.e. 2 hours before surgery. According to the data obtained, the vast majority of respondents (85.8%) prescribe pharmacological prevention of aspiration during planned surgical interventions.
Conclusions. The vast majority of anesthesiologists in Vinnytsia and Vinnytsia region follow the current recommendations of clinical guidelines regarding preoperative fasting and prevention of aspiration in obstetric patients.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Respondents informed consent was obtained for the study.
No conflict of interests was declared by the authors.
Keywords: Cesarean section, preoperative period, enteral nutrition, prevention of aspiration.

REFERENCES

1. Aguilar-Nascimento JE, Dock-Nascimento DB. (2010). Reducing preoperative fasting time. World Journal of Gastrointestinal Surgery. 2 (3): 57-60. https://doi.org/10.4240/wjgs.v2.i3.57; PMid:21160851 PMCid:PMC2999216

2. Allen C, Beverley L, Bovey J, Brady M, Darnley I, Dearmum A et al. (2005). Perioperative Fasting in Adults and Children: An RCN Guideline for the Multidisciplinary Team. (Clinical Practice Guidelines). RCNi. URL: https://media.gosh.nhs.uk/documents/RCN_Perioperative_Fasting_Adults_and_Children.pdf.

3. Bilehjani E, Fakhari S, Yavari S, Panahi J, Afhami M, Nagipour et al. (2015). Adjustment of Preoperative Fasting Guidelines for Adult Patients Undergoing Elective Surgery (Short Paper). Open J Intern Med. 5 (4): 115-118. https://doi.org/10.4236/ojim.2015.54016

4. Bollag L, Lim G, Sultan P, Habib AS, Landau R, Zakowski M et al. (2021). Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean. Anesth Analg. 132 (5): 1362-1377. https://doi.org/10.1213/ANE.0000000000005257; PMid:33177330

5. Brady M, Kinn S, Stuart P. (2003). Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev: 4. CD004423. https://doi.org/10.1002/14651858.CD004423; PMid:14584013

6. Carli F. (2015). Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response. Can J Anaesth. 62 (2): 110-119. https://doi.org/10.1007/s12630-014-0264-0; PMid:25501695

7. Cooke RD, Comyn DJ, Ball RW. (1979). Prevention of postoperative nausea and vomiting by domperidone: A double-blind randomized study using domperidone, metoclopramide and a placebo. S Afr Med J. 56 (21): 827-829.

8. Dewan DM, Floyd HM, Thistlewood JM, Bogard TD, Spielman FJ. (1985). Sodium citrate pretreatment in elective cesarean section patients. Anesth Analg. 64 (1): 34-37. https://doi.org/10.1213/00000539-198501000-00007

9. Garland J, Little D. (2018). Maternal Death and Its Investigation. Acad Forensic Pathol. 8 (4): 894-911. https://doi.org/10.1177/1925362118821485; PMid:31240079 PMCid:PMC6491542

10. He Y, Wang R, Wang F, Chen L, Shang T, Zheng L. (2022). The clinical effect and safety of new preoperative fasting time guidelines for elective surgery: a systematic review and meta-analysis. Gland Surg. 11 (3): 563-575. https://doi.org/10.21037/gs-22-49; PMid:35402209 PMCid:PMC8984990

11. Jasson J, Lefèvre G, Tallet F, Talafre ML, Legagneux F, Conseiller C. (1989). Oral administration of sodium citrate before general anesthesia in elective cesarean section. Effect on pH and gastric volume. Ann Fr Anesth Reanim. 8 (1): 12-18. https://doi.org/10.1016/S0750-7658(89)80136-4; PMid:2712403

12. Joshi GP, Abdelmalak BB, Weigel WA, Harbell MW, Kuo CI, Soriano SG et al. (2023). 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting. Anesthesiology. 138 (2): 132-151. https://doi.org/10.1097/ALN.0000000000004381; PMid:36629465

13. Lin CJ, Huang CL, Hsu HW, Chen TL. (1996). Prophylaxis against acid aspiration in regional anesthesia for elective cesarean section: a comparison between oral single-dose ranitidine, famotidine and omeprazole assessed with fiberoptic gastric aspiration. Acta Anaesthesiol Sin. 34 (4): 179-184.

14. Maltby JR, Sutherland AD, Sale JP, Shaffer EA. (1986). Preoperative oral fluids: is a five-hour fast justified prior to elective surgery? Anesthesia and Analgesia. 65 (11): 1112-1116. https://doi.org/10.1213/00000539-198611000-00003

15. Mandell LA, Niederman MS. (2019). Aspiration Pneumonia. N Engl J Med. 380 (7): 651-163. https://doi.org/10.1056/NEJMra1714562; PMid:30763196

16. Merchant R, Chartrand D, Dain S, Dobson G, Kurrek MM, Lagacé A et al. (2016). Guidelines to the Practice of Anesthesia – Revised Edition 2016. Can J Anaesth. 63 (1): 86-112. https://doi.org/10.1007/s12630-015-0470-4; PMid:26576558

17. MOZ Ukrainy. (2022). Pro zatverdzhennia Unifikovanoho klinichnoho protokolu pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy «Kesariv roztyn». Nakaz MOZ Ukrainy № 8 vid 05.01.2022. URL: https://www.dec.gov.ua/wp-content/uploads/2022/01/2022_08_ykpmd_kesar_roztyn.pdf.

18. NICE. (2021). Caesarean birth NICE guideline. URL: www.nice.org.uk/guidance/ng192.

19. Oodit R, Biccard BM, Panieri E, Alvarez AO, Sioson MRS, Maswime S et al. (2022). Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low – Middle-Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation. World J Surg. 46 (8): 1826-1843. https://doi.org/10.1007/s00268-022-06587-w; PMid:35641574 PMCid:PMC9154207

20. Ormezzano X, Francois TP, Viaud JY, Bukowski JG, Bourgeonneau MC, Cottron D et al. (1990). Aspiration pneumonitis prophylaxis in obstetric anaesthesia: Comparison of effervescent cimetidine-sodium citrate mixture and sodium citrate. Br J Anaesth. 64 (4): 503-506. https://doi.org/10.1093/bja/64.4.503; PMid:2334627

21. Pan PH, Moore CH. (2001). Comparing the efficacy of prophylactic metoclopramide, ondansetron, and placebo in cesarean section patients given epidural anesthesia. J Clin Anesth. 13 (6): 430-543. https://doi.org/10.1016/S0952-8180(01)00294-X; PMid:11578887

22. Phillips S, Hutchinson S, Davidson T. (1993). Preoperative drinking does not affect gastric contents. British Journal of Anaesthesia. 70 (1): 6-9. https://doi.org/10.1093/bja/70.1.6; PMid:8431336

23. Practice guidelines for obstetric anesthesia: An updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. (2016). Anesthesiology. 124 (2): 270-300. https://doi.org/10.1097/ALN.0000000000000935; PMid:26580836

24. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. (2017). Anesthesiology. 126 (3): 376-393. https://doi.org/10.1097/ALN.0000000000001452; PMid:28045707

25. Smith I, Kranke P, Murat I, Smith A, O'Sullivan G, Søreide E et al. (2011). Perioperative fasting in adults and children: Guidelines from the European society of anaesthesiology. Eur J Anaesthesiol. 28 (8): 556-569. https://doi.org/10.1097/EJA.0b013e3283495ba1; PMid:21712716

26. Warner MA, Meyerhoff KL, Warner ME, Posner KL, Stephens L, Domino KB. (2021). Pulmonary Aspiration of Gastric Contents: A Closed Claims Analysis. Anesthesiology. 135 (2): 284-291. https://doi.org/10.1097/ALN.0000000000003831; PMid:34019629