The aim of this literature review is to critically analyse and synthesise relevant studies pertinent to the quality and standards of the current protocols on Preoperative fasting for elective surgical patients

Authors Avatar by alihopi202 (student)

Module – SHN 3017

Preoperative Fasting

Cohort – M10

Group B2

Student Number – 558211

Personal Tutor – Megan Rosser

Submission Date – 16/07/2012

Word Count – 3824


Introduction                                    3-4

Rationale                                        4-5

Research strategy                          5-6

Themes Identified                           6-15

Conclusion                                      15-16

Reference list                                  17-21


The aim of this literature review is to critically analyse and synthesise relevant studies pertinent to the quality and standards of the current protocols on Pre-operative fasting for elective surgical patients.

Whilst the introduction offers a brief synopsis of a literature review, it also comprises of the methodology, and provides a rationale, research strategies and critically analyses all relevant research within the main body, finally it will conclude all the literature and outline implications for change which will then lead on to form the basis for the management of change assignment in module eight.

Parahoo (2006) suggests that a literature review should detail the time frame within which the literature was selected, as well as the methods used to evaluate and synthesize findings of the studies in question. This consequently allows us to identify and critically evaluate all the literature on the chosen topic.  The framework chosen to critique the primary research articles was The Critical Appraisal Skills Programme (CASP); the purpose of CASP is to help provide the skills necessary for finding and critically evaluating the best scientific evidence on which to base health care decisions (CASP 1993).

From undertaking the literature review several themes became apparent, the three most significant themes that were identified will be discussed in the main body of the assignment; 1, Understanding the cause of aspiration for patients fasting prior to surgery, 2,the on-going debate for how long the patient should be nil by mouth and 3, barriers in implementing change.  Not only are these themes emphasized within the current evidence-based literature but are further accentuated by personal observation within the hospital environment

When caring for patients it is essential for nurses to use the current best practice and is able to read research critically.  Not all research is of good quality or of a high standard, and therefore nurses should not simply take research at face value simply because it has been published (Cullum and Droogan 1999, Polit and Beck 2006).  The methodology used for this literature review was both Quantitative and Qualitative research; quantitative research enables the collection of data by means of numbers, proportions and statistics (Coughlan et al 2007). According to Streubert and Carpenter (2011), guidelines are often based on positivist, quantitative data in accordance with the still prevalent biomedical paradigm. Qualitative research was noticeably scarce by comparison; nevertheless it highlighted the need for further research, not only for members of the multi disciplinary team but also the patients themselves.


The professional rationale for the chosen topic emanates from observing nursing staff whilst on various surgical placements within hospitals. The study has highlighted the lack of consistency with nursing staff as the review of the time-honoured tradition of nil by mouth after midnight has been challenged in recent years, thus causing confusion between nursing staff and patients.  According to Saqr amd Chambers (2006) it would seem that the current recommendations within the evidence based literature are still not being followed in the UK.

As a result of this some patients were being fasted for six hours, whilst others were subject to twelve hours, Anderson (2009) suggests that this can cause anxiety, hunger, thirst and dry mouth, it may also cause unnecessary concern about the upcoming procedure.

Although preoperative fasting guidelines have been updated, (the guidelines for fasting in elective patients are as follows:- Patients may drink clear fluids up to 2hrs prior to general or regional anaesthesia, and Patients should not take solid food 6 hrs prior to induction of anaesthesia (Soreide and Ljungqvist, 2006)), patients are still being fasted for too long.  Two British studies were completed, and demonstrated that unnecessarily long fasts still persist (Pearce and Rajakulendran 1999; Seymour 2000); one of these studies found that seventy nine out of ninety surgical patients fasted from liquids for an average of ten hours (range, three to eighteen hours), despite the hospital’s policy advising for a two-hour fluid fast (Seymour 2000).  Trends in healthcare are continually evolving and changing, and these fluctuations can have considerable implications for nursing practice and have detrimental health implications to patients.  The purpose of this assignment is to explore the reasons why patients are still subjected to unnecessarily long fasting times when new guidelines are in place and determine why as nurses we continue to use outdated practice guidelines.

Research strategies

A commodious search of the literature was undertaken, involving an initial search of the Cumulative Index to Nursing and Allied Health (CINAHL), Pub med, Medline (EBSCO), Cochrane Library – Cochrane Database of Systemic Reviews (Wiley) and PsycINFO (OVID), Google was also used to obtain up to date data.  Key search terms used were: pre operative fasting, elective surgery, effects of fasting, anaesthesia and nil by mouth prior to surgery.

The amount of hits varied for each search although effects of fasting generated an abundance of hits, at a staggering 13192; therefore it was essential to narrow down the search.  Various articles were rejected, such as relating to paediatrics, pre operative guidelines for children and pre-operative carbohydrates treatment.

Each paper was reviewed by title and abstract, furthermore only papers that were written in English were chosen.   The research includes articles from various different countries; the search was then limited to show articles which had full Portable Document Format (PDF) and Hyper Text Mark-up Language (HTML), which enabled the paper to be screened for eligibility. Although the research data collected had to be current within the past five years, this was not always possible as relevant articles that were researched were much older, dating from 1946 – 2007.

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It is a medical and legal requirement that a patient must not be anaesthetized without a period of fasting from fluids and food, except in the case of emergency surgery (O’Callaghan, 2002).  The rationale behind pre operative fasting is to minimize the risk of patient’s aspirating their stomach contents at induction of anaesthesia, which can be potentially fatal (Jester and Williams, 1999, Rowe, 2002, and Tudor, 2006).  If material is inhaled it acts as a foreign substance, it is irritating and causes an inflammatory reaction, and at the same time interferes with gaseous exchange.  The acidic nature of ...

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