Obstetric Anaesthesia Annual Scientific Meeting 2023

Sip til Send: Improving Pre-operative Fasting Times in Elective Caesarean section patients at Whipps Cross Hospital

Why are we undertaking this project?

Current international guidelines only allow consumption of clear fluids for a minimum of 2 hours prior to a procedure. (1)
Due to the unpredictable and complex nature of theatre, the reality is that patients fast for fluids for much longer than this.
Prolonged fasting causes patient anxiety, dehydration and increase rates of post operative nausea and vomiting.
Many centres in the UK have safely moved to more liberal fasting policies.

What did we do?

To establish the current duration of pre-operative fasting, an anonymous patient survey was completed for twelve patients undergoing a category 4 section over two weeks in October 2022.
An estimated fasting time was calculated using the time of last drink and the time the patient entered theatre.
A bespoke policy was created for Whipps Cross after discussion within the department. The team were not in favour of including drinks with 15ml of milk before 07:00.
We repeated our patient survey over 6 weeks from December 2022 and collected data for twenty-nine patients undergoing an elective caesarean section.
Negative events were reported and monitored via datix.

New pre-operative fasting guideline:

170ml/hour of clear fluids including black coffe/tea and juice until patients are sent for their caesarean section under regional anaesthesia.

What did we find?

100% of anaesthetists and 89% of midwives that completed our survey were in favour of allowing patients to drink clear fluids until sent for theatre.
Figure 2 illustrates the significant reduction in pre-operative fasting times for fluids after introduction of a new fasting policy. The median fasting time decreased from 308 minutes to 75 minutes.
Fewer patients reported symptoms of dehydration or anxiety, as demonstrated by table 1.
There were no reports of pulmonary aspiration.

Discussion

Reducing the duration of fasting has a very positive impact on patients and is strongly supported by the multi-disciplinary team.
We would like to further reduce the pre-operative fasting time by educating patents about the importance to stay hydrated.
Following the success of our new policy, our aim is to extend this to trauma and elective surgery patients.

Reducing prolonged fasting times by implementing a 'Sip Til Send' policy for category 3 and 4 Caesarean sections at Whipps Cross