Knowledge, attitudes and practice of preoperative fasting guidelines in the National Hospital of Sri Lanka

Background
Recent guidelines on preoperative fasting recommend 2 hours for clear fluids and 6 hours for solids in most elective surgical patients^1,2. Despite this contemporary practice varies widely across the country. This study evaluates the knowledge, current practices and compliance with guidelines.

Method
This was a cross-sectional study. Data was obtained from patients attending for elective surgeries in NHSL during July 2010 and from junior anaesthetists, intern medical officers (IMO) and nurses of surgical wards. ASA practice guideline was the standard of assessment.

Results
235 patients and 118 healthcare workers were included. The mean duration of fasting was 13.86 hours (range 8 – 18) for solids and 12.68 hours for liquids (4 – 18). All junior anaesthetists and 64.3% of IMOs had above satisfactory level of knowledge. Nurses had below satisfactory knowledge. Only 58.3% of anaesthetists and none of the nurses or IMOs have adhered to guidelines.  81% patients stated that they would refuse a meal at 2 am but 66% would have appreciated a cup of tea 2 hours before surgery.

Conclusion
Patients undergoing routine surgery fast for unnecessarily long periods. Failure of implementation of guidelines is mainly due to inadequate knowledge and poor attitude among ward staff. More pragmatic approach is needed to assure that fasting instructions are consistent with the ASA guidelines and that patients understand and comply with these directives.

DOI: http://dx.doi.org/10.4038/slja.v20i2.4259

Sri Lankan Journal of Anaesthesiology.2012:20(2):92-95