Directorate of Distance Education

Swami Vivekanand Subharti University

Directorate of Distance Education

Title of the Project

A cross sectional study to assess the preoperative fasting hours among
patients for elective surgery in INHS Asvini, Mumbai.

Directorate of Distance Education

Swami Vivekanand Subharti University
Meerut

Submitted for partial fulfilment for award of the degree in

Master in Business Administration

By Student : Under The Supervision of:

Name- Monalisha Jana Mr. Ankush Sinha Ray
Enrolment No.- A1720414605448
Batch- June 2019

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Personal Profile (CV)

Name Monalisha Jana

Age 27 years

Sex Female

Marital status Single

Nationality Indian

Religion Hindu

Date of birth 03.04.1992

Languages known English, Bengali, Hindi

Mother tongue Bengali

Permanent Address Vill-Sundra, PO- Madhyahingly,

PS -Mahishadal, Dist-Purba Medinipur
Pin-721628, West Bengal
Academic Qualification :-
Name of the Course University /Board Year Percentage
Secondary Examination West Bengal Board of 2007 84.25
Secondary Examination
Higher Secondary West Bengal Council of Higher 2009 84.6
Examination Secondary Examination
Bsc Nursing West Bengal University Of 2009- 75.53
Health Sciences 2013

Working Experience :-
Date (From- To) Name of Institution Position
12.08.2013-31.01.2017 Tata Medical Center Shift In Charge (OT)
08.02.2017-Till Date) Military Hospital, Ahmednagar Senior Nursing Officer

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CV of the Guide

Name Ankush Sinha Ray

Age 26 years

Sex Male

Marital status Single

Nationality Indian

Religion Hindu

Date of birth 06.07.1993

Languages known English, Bengali, Hindi

Mother tongue Bengali

Permanent Address Barasat, Kolkata, West Bengal

Academic Qualification :-
Name of the Course Institution Year % of marks
Integrated MBA (Finance KIIT School of Management 2014-2016 78.7
& Marketing)
Integrated B.tech KIIT University 2011-2015 78.3
Electronics &
Telecommunication
Std XII Army School Barrackpore 2011 83.4
(CBSE)
Std X Army School Barrackpore 2009 82.6
(CBSE)

Professional Experience :-
Date (From- To) Name of Institution Position
July 2016 to Till Date Tata Technologies Ltd, Jamshedpur SAP Functional
Consultant

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Certificate

This is to certify that Ms. Monalisha Jana has carried out the Project work
presented in this entitled “A cross sectional study to assess the preoperative
fasting hours among patients for elective surgery in INHS Asvini,
Mumbai” under my supervision and merits the award of Master in Business
Administration from Swami Vivekanand Subharti University. The Project
embodies result of original work and studies carried out by Student herself
and the contents of the Project do not form the basis for the award of any
other degree to the candidate or to anyone else.

Signature of the Student

Name of the Student: Monalisha Jana
Enrollment no: A1720414605448
Address: Vill-Sundra, PO- Madhyahingly, PS -Mahishadal, Dist-Purba
Medinipur , Pin-721628, West Bengal.

Signature of the Guide:

Name of the Guide: Ankush Sinha Ray
Designation: Functional Consultant
Address: Barasat, Kolkata, West Bengal

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TABLE OF CONTENTS

CHAPTER TITLE PAGE NO.

NO.
Acknowledgement 1

Preface 2-3
Chapter 1 Introduction to Preoperative Fasting 4-7
1.1 Introduction 4-5
1.2 Need of the Study 6
1.3 Statement of the problem 6
1.4 Objectives of the study 6
1.5 Operational definitions 7
1.6 Delimitations of the study 7
Chapter 2 Review of Literature 8-14
Chapter 3 Research Methodology 15-17
Chapter 4 Date analysis and interpretation 18-31
Chapter 5 Findings, Recommendations & conclusion 32-36
5.1 Findings 32-34
5.2 Recommendations 35
5.3 Conclusion 36
Bibliography 37
Appendix 38-41
A. Abbreviation & symbols used in the 39
Project
B. Questionnaire 40-41

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LIST OF TABLES/FIGURES

S. TITLE OF THE TABLES/FIGURES PAGE

NO. NO

1. Pie diagram on gender distribution 19

2. Bar diagram on age distribution 20
3. Bar diagram on comorbidity present in the patients underwent 21
surgery
4. Bar diagram on distribution of population based on surgical 22
specialty
5. Pie diagram on types of anaesthesia performed 23
6. Pie diagram on fasting guideline according to PAC 24
7. Pie diagram on source of information 25
8. Pie diagram on awareness regarding importance of fasting 26
9. Bar diagram on knowledge of patients on preoperative fasting 26
10. Pie diagram on operation theatre in time 27
11. Bar diagram on hours of fasting at the time of arrival to the 28
operation theatre
12. Bar diagram on hours of fasting prior to anaesthesia 29
13. Pie diagram on intervention given preoperatively 30
14. Bar diagram on duration of surgery 31
15. Table on mean, median, mode, standard deviation of collected 31
data.

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ACKNOWLEDGEMENT

I would like to express our deep and sincere gratitude to Surg Rear Adm

Naveen Chawla, VSM, Commanding Officer, INHS ASVINI, Mumbai for

permitting us to utilize resources in his flagship for our research study. I

extend my sincere gratitude to Brig Omana Bharathan, Principal Matron,

INHS ASVINI for her support for successful completion of my research

project.

I am also immensely grateful to Surg Capt S N Kulkarni, HOD, Dept. Of

Anaesthesia for his support and valuable suggestions. I would also like to

show my gratitude to Col Amit Rai, MO/IC, operation Theatre for his support

and guidance throughout the research . It is my pleasure to thank Lt Col G

Novanita, my Course Coordinator , for the support and encouragement.

Finally, my thanks go to all the people who have supported me to complete

the research work directly or indirectly.

MONALISHA JANA

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PREFACE:

Background: Preoperative fasting (POF) is physiologically and precautionary

important during anaesthesia and surgery. POF from midnight has been

practiced despite the recommended shorter practice. Objective: Assessing

preoperative fasting among adult patients scheduled for elective surgery at

INHS ASVINI, MUMBAI. Methods: A cross-sectional study involving 125

patients. A questionnaire of mixed questions on demographics, reasons,

source of instructions, opinion on instructions, hours of fasting, importance of

fasting preoperatively was used. Results: Demographically, 52% were male

and 48% were female. It is been observed that 26.4% of selected population

were having comorbidities. A majority (70%) of the population underwent

surgical procedure under general anaesthesia. Local anaesthesia was used for

only 11% of the population. A majority (99.2%) of the population were

instructed not to take anything by mouth after 2200 hours and rest after 0001

hours. A majority (88%) of the population stated that they got information

from all three sources i.e. Anaesthetist, Surgeon and Nursing Officer, whereas

only 12% population reported that they got information from any two source.

A majority (62%) of the population taken inside the operation theatre before

1100 hours and rest (38%) were taken after 1100 hours. A majority (60.8%)

of the population fasted for 10-15 hours when they arrived to operation

theatre, whereas 36.8% of the population for 15-20 hours, 1.6% of the

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population for 0-5 hours and 0.8% of the population for 20-25 hours. A

majority (92%) of the population fasted for 10-15 hours before induction of

anaesthesia, whereas 4.8% of the population for 5-10 hours and 1.6% of the

population fasted for 10-15 hours and 0-5 hours. A majority (80%) of the

population were well aware about the importance of fasting, namely chances

of vomiting (70%), breathing problem (10%). Nearly 15% were not knowing

the reason, while 5% gave irrelevant answers like to avoid side effects (4%),

to empty bowel (1%).

Conclusion: Patients were well aware about the importance of fasting prior to

surgery, the mean fasting period was 2.37 times longer than the ASA

guideline.

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CHAPTER - 1
INTRODUCTION TO
PREOPERATIVE FASTING

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CHAPTER 1
1.1 INTRODUCTION

Preoperative fasting (POF) is a time tested professional practice that is

undertaken for physiological and precautionary benefits to the patients
globally. Patients are deprived of certain and/or all foods and drinks for
specific duration before surgery. For clinical purposes, POF is abstinence
from all foods and liquids for a specified period of time before induction of
anaesthesia and/or commencement of surgery. The duration for POF is
dictated by the type of diet, patient condition, and the kind of surgery whether
emergency or elective among other factors. Some diets, regardless of their
texture (solids or fluids), are easily digestible, thus allowing for rapid
elimination from the stomach, while others are slow release type stagnating in
the gastrointestinal tract. The POF provides empty or near empty stomach, a
critical requirement for emergency, and elective surgical interventions. The
POF intervention ensures physiological stability, reduction of complications,
hospital stay, and costs. The practice is structured to include well-planned and
packaged health information on the goal and expectations for the patient thus,
promoting compliance and allaying anxiety.
Physiologically, the goal of POF is to minimize the risk of regurgitation,
vomiting, aspiration, and the complications thereof during anaesthesia or
surgery.
The instructions (health messages) for POF are issued by clinical team
members, namely, nurses, physicians, anaesthetists, or surgeons.
A shortened POF time based on evidence based guidelines is beneficial to the
patient because it increases postoperative comfort, improves insulin
resistance, and reduces stress responses. However, the adoption of the
reviewed POF guidelines and their attendant benefits has been inconsistent
globally.

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1.2 NEED OF THE STUDY

Preoperative fasting is the part of the process of preoperative evaluation and

preparation of the patient. Although the ASA guidelines recommend that
preoperative fasting for solid and nonhuman milk should be 6 hours and for
clear fluid should be 2 hours, the actual fasting times of patients are far from
these recommendations. This study is designed to evaluate the preoperative
fasting times and how it differs from recommended guidelines.

1.3 STATEMENT OF THE PROBLEM

A cross sectional study to assess the preoperative fasting hours among

patients for elective surgery in INHS Asvini, Mumbai.

1.4 OBJECTIVES

 To evaluate the duration of fasting preoperatively

 To assess the knowledge level of the patients regarding importance of
fasting
 To reduce the severity of complications related to perioperative
pulmonary aspiration
 To enhance the quality and efficiency of anesthesia care
 To determine factors leading to prolonged fasting hours and to
recommend appropriate solutions

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1.5 OPERATIONAL DEFINITIONS

Cross sectional study : It is a type of observational study that analyses data

from a population, at a specific point in time.

Assessment: The term assessment refers to the wide variety of methods or

tools that are used to evaluate, measure or making a judgment about
something.

In this study it refers to the act of determining the preoperative fasting hours
as measured by an open and closed ended questionnaire.

Pre-Operative Fasting: It is the practice of a patient abstaining from oral

food and fluid intake for a time before an operation is performed.

Patient : A person receiving or registered to receive medical treatment.

Elective Surgery: Surgery that is subject to choice (election). The choice

may be made by the patient or doctor.

1.6 DELIMITATION:

 Lack of reliability.
 Faulty perception.
 Personal bias of the observer.
 Inadequate method.
 Difficulty in checking validity.

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CHAPTER – 2

REVIEW OF LITERATURE

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CHAPTER 2

REVIEW OF LITERATURE

Der anaesthetist 52(11) 200

In Germany the predominant standard of preoperative care for elective

surgery is fasting after midnight, with the aim of reducing the risk of
pulmonary aspiration. However, for the past several years the scientific
evidence supporting such a practice has been challenged. Experimental and
clinical studies prove a reliable gastric emptying within 2 h suggesting that,
particularly for limited intake of clear fluids up to 2 h preoperatively, there
would be no increased risk for the patient. In addition, the general incidence
of pulmonary aspiration during general anaesthesia (before induction, during
surgery and during recovery) is extremely low, has a good prognosis and is
more a consequence of insufficient airway protection and/or inadequate
anaesthetic depth rather than due to the patient's fasting state. Therefore,
primarily to decrease perioperative discomfort for patients, several national
anaesthesia societies have changed their guidelines for preoperative fasting.
They recommend a more liberal policy regarding per oral intake of both liquid
and solid food, with consideration of certain conditions and contraindications.
The following article reviews the literature and gives an overview of the
scientific background on which the national guidelines are based. The
intention of this review is to propose recommendations for preoperative
fasting regarding clear fluids for Germany as well.

The British Journal of Surgery (01 Apr 2003)

To avoid pulmonary aspiration, fasting after midnight has become standard in

elective surgery, but recent studies have found no scientific support for this
practice. Several anaesthesia societies now recommend a 2-h preoperative fast
for clear fluids and a 6-h fast for solids in most elective patients. The

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literature supporting such fasting recommendations was reviewed. The

recommendations are safe and improve well-being before operation, mainly
by reducing thirst. A carbohydrate-rich beverage given before anaesthesia and
surgery alters metabolism from the overnight fasted to the fed state. This
reduces the catabolic response (insulin resistance) after operation, which may
have implications for postoperative recovery. Most patients having elective
operations can be allowed a free intake of clear fluids up to 2 h before
anaesthesia. Preoperative carbohydrates reduce postoperative insulin
resistance.

The European journal of Anaesthesiology (01 Aug, 2011)

This guideline aims to provide an overview of the present knowledge on

aspects of perioperative fasting with assessment of the quality of the evidence.
A systematic search was conducted in electronic databases to identify trials
published between 1950 and late 2009 concerned with preoperative fasting,
early resumption of oral intake and the effects of oral carbohydrate mixtures
on gastric emptying and postoperative recovery. One study on preoperative
fasting which had not been included in previous reviews and a further 13
studies published since the most recent review were identified. The searches
also identified 20 potentially relevant studies of oral carbohydrates and 53 on
early resumption of oral intake. Publications were classified in terms of their
evidence level, scientific validity and clinical relevance. The Scottish
Intercollegiate Guidelines Network scoring system for assessing level of
evidence and grade of recommendations was used. The key recommendations
are that adults and children should be encouraged to drink clear fluids up to 2
h before elective surgery (including caesarean section) and all but one
member of the guidelines group consider that tea or coffee with milk added
(up to about one fifth of the total volume) are still clear fluids. Solid food
should be prohibited for 6 h before elective surgery in adults and children,

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although patients should not have their operation cancelled or delayed just
because they are chewing gum, sucking a boiled sweet or smoking
immediately prior to induction of anaesthesia. These recommendations also
apply to patients with obesity, gastro-oesophageal reflux and diabetes and
pregnant women not in labour. There is insufficient evidence to recommend
the routine use of antacids, metoclopramide or H2-receptor antagonists before
elective surgery in non-obstetric patients, but an H2-receptor antagonist
should be given before elective caesarean section, with an intravenous H2-
receptor antagonist given prior to emergency caesarean section, supplemented
with 30 ml of 0.3 mol l(-1) sodium citrate if general anaesthesia is planned.
Infants should be fed before elective surgery. Breast milk is safe up to 4 h and
other milks up to 6 h. Thereafter, clear fluids should be given as in adults. The
guidelines also consider the safety and possible benefits of preoperative
carbohydrates and offer advice on the postoperative resumption of oral intake.

The West Indian Medical Journal (01 Dec 2002)

The fear of aspiration of gastric contents and its life-threatening consequences

in patients (aspiration pneumonitis and respiratory failure), has caused many
medical practitioners, particularly anaesthetists, to rigidly follow conservative
(i.e. prolonged) preoperative fasting standards. This is the nil per orally
(NPO) order for clear fluids/liquids and solids overnight or six to eight hours
preceding the induction of anaesthesia. This practice neither takes into
account the differences in the rate of gastric emptying for solid food (which
may exceed six hours) and clear liquids (which is one to two hours), nor the
differences in scheduled times of surgery. Long-term prospective studies and
retrospective reviews have shown that the incidence of significant clinical
aspiration is low: 1.4-6.0 per 100,00 anaesthetics for elective general surgery.

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Risk factors for pulmonary aspiration include: a high American Society of

Anaesthesiologists (ASA) physical status score; emergency surgery; difficult
airway management; increased gastric volume and acidity; increased intra-
abdominal pressure; gastro-oesophageal reflux; oesophageal disease; head
injury with impaired consciousness and extremes of age. Experimental studies
and reviews have consistently shown the safety of clear liquid ingestion up to
two hours before induction of anaesthesia in healthy patients without risk
factors, and the fact that a longer fluid fast does not necessarily offer any
added protection against pulmonary aspiration. The conservative pre-
operative fasting standard causes discomfort and in some cases, suffering of
patients and is therefore unnecessary for patients without risk factor(s).
Anecdotal reports at the University Hospital of the West Indies (UHWI) have
shown that application of the liberalized guidelines for preoperative fasting
and fluid intake has not resulted in increased pulmonary aspiration, morbidity
or mortality. Instead it has resulted in decreased irritability, anxiety, thirst and
hunger in the peri-operative period. Patients, especially children are more
comfortable and the perioperative period is better tolerated. It is therefore
time that all medical personnel adopt the liberalized guidelines.

BMJ Open Qual Nov 2018

Preoperative fasting is necessary to reduce the risk of regurgitation of gastric

contents and pulmonary aspiration in patients undergoing general anaesthetic
and procedural sedation. Excessive fasting is associated with metabolic,
cardiovascular and gastrointestinal complications and patient discomfort. We
aimed to reduce the fasting time for patients on the plastic surgery trauma list.
Adult inpatients awaiting surgery were asked to complete a preoperative
assessment sheet. Questions included the length of preoperative fasting,

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clarity of instructions and wellness scores. Three cycles of data collection

were performed over a 12-month period, patients who declined to participate
or were unable to consent were excluded. The first cycle revealed the need for
significant improvement. Interventions included staff education, patient
information sheets, preoperative drinks, greater availability of ward snacks
and improved communication between the ward staff and surgical team
through our electronic trauma database. The initial audit of 15 patients
revealed a mean fasting time of 16.3 hours for fluid (range 10–22) and a mean
of 19.3 hours for solid food (range 10–24). The mean wellness score was 6/10
(10 being very well), 67% of patients felt they were given clear information.
The final cycle demonstrated clear improvement in all domains. The mean
fasting time declined to 5.1 hours for fluid (range 3–10 hours) and 13 hours
for solid food (range 7.5–17 hours). The mean wellness score (10=very well)
increased from 6 to 8, the mean thirst score declined from 6.1 to 5.1 and
100% patients felt they had been given clear information. Removal of the
traditional ‘NBM from midnight’, patient education, a clear fasting routine
with preoperative drinks and improved communication between the full
multidisciplinary team has led to a reduction in the fasting times on our
trauma list.

International Scholarly Research Notices 2017

Preoperative fasting (POF) is physiologically and precautionary important

during anesthesia and surgery. POF from midnight has been practiced despite
the recommended shorter practice. Objective. Assessing preoperative fasting
among adult patients scheduled for elective surgery at Kenyatta National
Hospital (KNH).Methods. A descriptive cross-sectional study involving 65
surgical patients. A questionnaire of mixed questions on demographics,
reasons, source of instructions, opinion on instructions, time, premedication

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practices, outcome, and complains on NPO was used. Analysis was

quantitatively done with SPSS v. 22. Ethical approval was obtained from
KNH-UoN ERC. Results. Of the respondents 93.8% lacked knowledge on the
correct reasons for POF and felt that the instructions were unclear and less
important <50%. POF instructions were administered by nurses 80%,
anesthetists 15%, and surgeons 5%. Most of respondents (73.8%) fasted > 15
hours. The POF outcomes were rated moderately challenging as follows:
prolonged wait for surgery 44.6%, thirst 43.1%, hunger 36.9%, and anxiety
29.2%. Conclusion. Nurses are critical in providing POF instructions and
care, and patient knowledge level is a mirror reflection of the quality of
interventions. This underscores the need to build capacity for nurses and
strengthen the health system to offer individualized preoperative interventions
as well as monitoring and clinical auditing of fasting practices.

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CHAPTER – 3

RESEARCH METHODOLOGY

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CHAPTER 3

METHODOLOGY:

This is a cross-sectional study involving purposively selected respondents

from different wards at INHS, Asvini, Mumbai conducted between 25th Feb
2019 to 9th Mar 2019 for a period of two weeks. Permission was taken from
the Head of the Department (OT). Samples were selected by simple random
sampling within them. A total of 125 samples were selected for study.
Purpose of the study were explained to them. Their consent was acquired and
the method of answering the questionnaire, the time duration needed, scoring
techniques was explained to the subjects.

Data was collected using a self-administered structured questionnaire

developed by the researchers. The questionnaire was structured into closed
ended questions for the quantitative data, as well as open-ended ones for the
qualitative data. The components in the questionnaire included demographic
characteristics, comorbidities, source of POF instructions, importance of
fasting preoperatively.

A checklist was developed that addressed patient identity, diagnosis, type of

operation, types of anaesthesia given, fasting guideline according to PAC,
total hours of fasting at the time of arrival to the OT, total hours of fasting at
the time of induction of anaesthesia, OT in time, any interventions taken,
duration of surgery.

The questionnaire was administered when the patient arrived to the

preoperative room. Data was collected using a checklist and self-administered
questionnaire among the literate respondents, while those with literacy

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challenges were helped in reading and filling the questionnaires by trained

research assistants.

The quantitative data was screened, coded, and entered into the analytical
computer software (SPSS v. 22) and analysed. The descriptive and inferential
statistics were generated and reported accordingly. Specifically, the mean,
mode, median, standard deviation were generated and discussed. The
qualitative data generated from the open-ended questions was screened and
organized and repeating themes were grouped together. The most common
repeating themes were manually identified, captured, and the quotes have
been included in the results.

Consent was obtained from the subjects both verbally and in written form
before data collection.

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CHAPTER-4

DATA ANALYSIS

&

INTERPRETATION

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CHAPTER 4

DATA ANALYSIS & INTERPRETATION

1. Demographic characteristics of the Respondents :

Gender Distribution:

GENDER

FEMALE
MALE
48%
52% MALE
FEMALE

Figure (i)

Interpretation : Demographically, 52% were male and 48% were female.

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Age Distribution:

35

30

25

20

15

10

0
AGE
0- 15 YRS 16- 30 YRS 31-45 YRS 46-60 YRS 61-75 YRS 76-90 YRS

Figure (ii)

Interpretation : Majority (26.4%) were belong to the age group of 15 years

to 30 years, whereas only 4% belongs to the age group of 76 years to 90
years. Followed by 23.2% in the age group of 46 years to 60 years; 21.6% in
the age group of 31 years to 45 years ; 20% in the age group of 61 years to 75
years; 4.8% in the age group of 1 month to 15 years.

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2. Health status of people underwent elective surgical procedure :

COMORBIDITY

14

12

10

0
COMORBIDITY

HTN DM CKD HYPOTHYROIDISM CVA IHD OBESITY ASTHMA

Figure (iii)

Interpretation : It is been observed that 26.4% of selected population

were having comorbidities such as Hypertension ( 10.4%), diabetes
mellitus (6.4%), CKD (3.2%), hypothyroidism (3.2%), obesity (0.8%),
IHD (0.8%), CVA (0.8%), asthma ((0.8%).

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3. Distribution of population based on surgical speciality

NUMBER OF SURGERIES ACCORDING TO

DEPARTMENT
30

25

20

15

10

0
DEPARTMENT
GI NEURO CTVS ORTHO
URO GYNAE ENT RECONSTRUCTION
VASCULAR ONCOLOGY

Figure (iv)

Interpretation : A majority (22.4%) of the population underwent

obstetrical and gynaecological surgeries, while 15.2% underwent
orthopaedic surgeries, 14.4% underwent GI surgeries, 10.4%
underwent urologic surgeries, 7.2% in both ENT and reconstructive
surgeries, 6.4% in both the vascular and oncological surgeries,
followed by 5.6% neurological surgeries, 4.8% Cardio thoracic
vascular surgeries.

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4. Distribution of population based on techniques of anaesthesia

performed

TYPES OF ANAESTHESIA

11%

GENERAL
19%
SPINAL
LOCAL
70%

Figure (v)

Interpretation : A majority (70%) of the population underwent

surgical procedure under general anaesthesia. Local anaesthesia was
used for only 11% of the population.

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5. Population distribution based on fasting guideline followed as per

PAC :

FASTING GUIDELINE ACCORDING TO PAC

0.8%

2200 HRS
0000 HRS

99.2%

Figure (vi)

Interpretation : A majority (99.2%) of the population were instructed

not to take anything by mouth after 2200 hours and rest after 0001 hrs.

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6. Source of preoperative fasting instructions among respondents:

SOURCE OF INFORMATION

ANAESTHETIST,
SURGEON, NURSING
12%
OFFICER

88%

Figure (vii)

Interpretation : The respondent reported mainly about three sources of

preoperative fasting instructions. A majority (88%) of the population
stated that they got information from all three sources i.e Anaesthetist,
Surgeon and Nursing Officer, whereas only 12% population reported
that they got information from any two source.

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7. Knowledge on preoperative fasting among respondents:

AWARENESS REGARDING IMPORTANCE

OF FASTING

20%
YES
NO

80%

Figure (viii)

KNOWLEDGE ON PREOPERATIVE FASTING

80

70

60

50

40

30

20

10

0
CHANCES OF BREATHING TO AVOID SIDE I DON’T KNOW TO EMPTY BOWEL
VOMITING PROBLEM EFFECTS

KNOWLEDGE ON PREOPERATIVE FASTING

Figure (ix)

Interpretation : A majority (80%) of the population were well aware

about the importance of fasting, namely chances of vomiting (70%),
breathing problem (10%). Nearly 15% were not knowing the reason,
while 5% gave irrelevant answers like to avoid side effects (4%), to
empty bowel (1%).

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8. Distribution of population according to the operation theatre in

time :

TIME OF SURGERY

38%
BEFORE 1100 HRS
AFTER 1100 HRS
62%

Figure (x)

Interpretation : A majority (62%) of the population taken inside the

operation theatre before 1100 hrs and rest (38%) were taken after 1100
hrs.

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9. Duration of preoperative fasting among selected population at the

time of arrival to the OT :

HOURS OF FASTING AT THE TIME OF ARRIVAL TO THE

OT
140

120

100

80

60

40

20

0
0-5 HRS 5-10 HRS 10-15 HRS 15-20 HRS

Figure (xi)

Interpretation : A majority (92%) of the population fasted for 10-15

hours, whereas
4.8% of the population for 5-10 hours and 1.6% of the population
fasted for 10-15 hours and 0-5 hours.

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10.Duration of preoperative fasting among selected population prior

to anaesthesia:

HOURS OF FASTING PRIOR TO ANAESTHESIA

80

70

60

50

40

30

20

10

0
0-5 HRS 5-10 HRS 10-15 HRS 15-20 HRS 20-25 HRS

HOURS OF FASTING

Figure (xii)

Interpretation : A majority (60.8%) of the population fasted for 10-15

hours, whereas 36.8% of the population for 15-20 hours, 1.6% of the
population for 0-5 hours and 0.8% of the population for 20-25 hours.

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11.Distribution of population based on intervention undertaken

preoperatively :

INTERVENTION GIVEN

Yes
0%

No
100%

Figure (xiii)

Interpretation : It is been observed that no respondent receive any

intervention preoperatively.

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12.Distribution of population according to duration of surgery :

DURATION OF SURGERY
50
45
40
35
30
25
20
15
10
5
0
0-1 HRS 1-2 HRS 2-3 HRS 3-4 HRA 4-5 HRS 5-6 HRS 6-7 HRS 7-8 HRS 8-9 HRS 9-10 HRS

HOURS OF SURGERY

Figure (xiv)

Interpretation : A majority (36.8%) population underwent surgical

procedures of 1-2 hours, whereas 25.6% of the population for 0-1 hour,
17.6% of the population for 2-3 hours, 9.6% of the population for 3-4
hours, 2.4% of the population for 4-5 hours, 3.2% of the population for
6-7 hours, 2.4% of the population for 7-8 hours, 1.6% of the population
for 8-9 hours and only 0.8% of the population for 9-10 hours.

PARAMETERS MEAN MEDIAN MODE STANDARD

DEVIATION(±)
Age (Years) 43.8 44 62 18.51
Hours of fasting at the time of 11.76 12.1 12.3 1.628
arrival to the OT (Hours)
Hours of fasting before induction 14.28 14.05 13.3 2.639
of anaesthesia (Hours)
Duration of surgery (Hours) 2.19 2 1 1.912
Table (i)

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CHAPTER – 5
FINDINGS,
RECOMMENDATIONS
&
CONCLUSION

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CHAPTER-5
5.1 FINDINGS
The findings of our study are summarized as follows:
Most of the patients fasted from food and fluid longer than the time
recommended by most of the international guidelines. This might have
many adverse consequences such as hunger, thirst, headache,
dehydration, hypoglycaemia, delayed awakening after anesthesia, and
poor patient outcome after surgery. The reasons for the prolonged
fasting in our hospital might be the tradition of ordering patients to be
NPO after 2200 hrs and standardized dinner time at 1900 hrs.

In addition, there was no trend of revising the operation lists and

ordering patients to take food and/or fluid whenever surgery was
delayed. These data showed that most of the time patients were fasting
for prolonged period, and there was no concern about the duration of
fasting and the sequence of operation schedule lists in our hospital by
the surgical team whenever surgery was delayed.

Maximum duration of POF was 20 hours 50 minutes and mean was 14

hours 20 minutes, but it is remarkable that no intervention was given
preoperatively.

It has been observed that patients who came in last sequence in a

particular OT suffered more fasting hours.

It is been observed that 26.4% of selected population were having

comorbidities. A majority (22.4%) of the population underwent
obstetrical and gynaecological surgeries.

The respondent reported mainly about three sources of preoperative

fasting instructions. A majority (88%) of the population stated that they

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got information from all three sources i.e. Anaesthetist, Surgeon and
Nursing Officer, whereas only 12% population reported that they got
information from any two source.

A majority (80%) of the population were well aware about the

importance of fasting, namely chances of vomiting (70%), breathing
problem (10%). Nearly 15% were not knowing the reason, while 5%
gave irrelevant answers like to avoid side effects (4%), to empty bowel
(1%).

A majority (92%) of the population fasted for 10-15 hours, whereas

4.8% of the population for 5-10 hours and 1.6% of the population
fasted for 10-15 hours and 0-5 hours.
A majority (60.8%) of the population fasted for 10-15 hours, whereas
36.8% of the population for 15-20 hours, 1.6% of the population for 0-5
hours and 0.8% of the population for 20-25 hours.
A majority (36.8%) population underwent surgical procedures of 1-2
hours, whereas 25.6% of the population for 0-1 hour, 17.6% of the
population for 2-3 hours, 9.6% of the population for 3-4 hours, 2.4% of
the population for 4-5 hours, 3.2% of the population for 6-7 hours,
2.4% of the population for 7-8 hours, 1.6% of the population for 8-9
hours and only 0.8% of the population for 9-10 hours.

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5.2 RECOMMENDATIONS

 Distinguished fasting instructions for solid (6 hours) and clear fluids (2

hours)
 Scheduled operation time could also be included in the operation list so
as to reduce fasting hours.
 Traditional local fasting guideline should be eliminated and the ASA
fasting guideline should be initiated
 Interventions should be initiated if the preoperative fasting hours is
exceeding 10 hours.

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5.3 CONCLUSION

Having a hungry and thirsty patient anxiously waiting for a procedure

adversely impacts the patient's experience. The majority of patients fasted
from both food and fluid longer than the fasting time recommended by the
AAGBI, ASA, RCOA and RCN guidelines. There was no trend by
anesthetists, surgeons, and operating theatre nurses of revising the schedule
lists and ordering patients to take a light meal or fluid whenever the surgery
delayed. Anesthetists, surgeons, and nurses need to revise and discuss the
scheduled lists every day in the operating theatres and resuscitate the patients
accordingly. Finally, the use of fasting status provides an accurate measure of
the patient experience, patient safety, and operational efficiency. It is
particularly valuable for objectively measuring the patient’s experience. For
example, asking a general question of how a patient felt about his experience
is an indirect measure of several variables and is ultimately subjective.
Monitoring patients’ fasting times yields an objective look at safety,
efficiency, and experience variables. Monitoring fasting times would also be
valuable both internally to monitor and track progress and externally to
compare institutions with each other.

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BIBLIOGRAPHY

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APPENDICES

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A. Abbreviations & symbols used in the Project:

 HOD- Head of Department

 POF- Preoperative fasting
 INHS- Indian Naval Hospital Ships
 NPO- Nil per Orally
 UHWI- University Hospital of the West Indies
 KNH- Kenyatta National Hospital
 OT- Operation Theatre
 SPSS - Statistical Package for the Social Sciences
 AAGBI- Association of Anaesthetists of Great Britain and Ireland
 RCOA- Royal College of Anaesthetists
 RCN- Royal College of Nursing
 ASA- American Society of Anesthesiologists
 PAC- Pre Anaesthetic Check-up
 VSM- Vishisht Seva Medal

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B. Questionnaires :
1. Age of the respondent
A. 0-15 years
B. 16-30 years
C. 31-45 years
D. 46-60 years
E. 61-75 years
F. 76-90 years
2. Sex of the respondent
A. Male
B. Female
3. Do you have any known morbidity, if yes then
A. Hypertension
B. Diabetes mellitus
C. Chronic kidney disease
D. Asthma
E. Others specify
4. When you had your last meal (solid)?
5. When was your last fluid intake?
6. When did you reach operation theatre?
7. Any incidence of giddiness, fainting?
A. No
B. Yes , if yes what intervention given?
8. Do you think fasting before surgery is important?
A. Yes
B. No
C. I don’t know

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9. If answer to the question no 8 is yes then why?

A. To prevent vomiting
B. To avoid breathing problem
C. To reduce side effects of anaesthesia
D. To empty bowel
E. I don’t know
F. All of the above
10. Instructions regarding fasting was conveyed by
A. Anaesthetist
B. Surgeon
C. Nursing officer
D. All of them
E. If others specify

CHECKLIST
Sl Name Age Sex Diagnosis Name Type of Fasting Time Time of OT in time Duration of
no. of of anesthesia guideline of induction surgery
patient surgery according to arrival of
Before After
PAC to OT anesthesia
11 Am 11Am

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