Do You Need to Starve Before Surgery?
Study suggests some patients could loosen up strict fasting rules for surgery.
March 25, 2009— -- 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.