Do You Need to Starve Before Surgery?

fasting before anesthesia

Lying in a hospital bed, it can be the most infuriating of responses. You've been suffering for hours in labor or awaiting a major surgery and all you ask for is a bite to eat.

But the nurse says no.

For generations, doctors have put patients on a strict fast before a major surgery. Ten years ago, the recommendation was no food or drink for eight hours before anesthesia. Not even a glass of water.

A toned-down version of the fasting rules even applies to women in labor on the off chance that things go wrong and the mother ends up in surgery.

But a group of researchers in the United Kingdom found evidence that hospitals may not need to be so strict in the maternity ward.

The study in the British Journal of Medicine tracked more than 2,000 mothers in labor. Half followed the traditional liquid diet fast and half were given permission to eat a light meal.

After the births, the study showed no difference in Caesarean rates and no difference in rates of complications if moms were given the chance to eat.

The doctors who led the study hope it will settle a debate in the medical field.

"It's really because it's quite a controversial area," said Dr. Andrew Shennan, a co-author of the study and a professor of obstetrics at King's College in London.

"Over the years there's been a general idea that women should starve during labor," he said.

The traditional fast for women in labor started as a safety precaution in the late 1940s, after doctors reported deaths from pulmonary aspiration in some women who had Caesareans.

Pulmonary aspiration is a nice medical way of describing when someone vomits and then inhales it back into their lungs, which can be quite serious and even cause death.

"When we're awake or when we're asleep we have protective reflexes to keep things out of our airways, but under anesthesia you lose your protective reflexes," said Dr. Craig Palmer, chairman of the Committee on Obstetric Anesthesia for the American Society of Anesthesiologists.

"The steps you would take to minimize the single death of an otherwise healthy woman are pretty dramatic," Palmer said. "We have to protect a lot of people to save one."

During the years, doctors have developed better anesthesia practices, especially for women in labor. Even if women need a Caesarean, doctors say they are far more likely to have local anesthesia that wouldn't require them to "go under."

However, the fasting rules for most patients haven't changed very much.

Why People Can't Eat Before Surgery

"Over the last decade or so, those guidelines have been loosened," said Palmer, who is also a professor of clinical anesthesiology at the University of Arizona in Tucson.

While before, patients could not let anything pass their lips for eight hours, now broth, energy drinks and tea are on the approved list, according to Palmer.

"Now we allow them to take clear liquids by mouth up to two hours before [surgery]," he said.

Women in labor haven't seen much relaxation of the rules either -- at least in the United States. The authors of the study cited that 79 percent of clinicians in the Netherlands allow women to eat during labor, versus 32 percent in the United Kingdom and even less in the United States.

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