Abbreviated preoperative fasting: why despite the evidence can't we do it?

Justification and Objectives: Despite the strong evidence, several institutions and services still apply old concepts about preoperative fasting, subjecting patients to prolonged periods of fasting. Thus, in conducting this work, we aim to understand the main obstacles to the abbreviation of preoperative fasting. Method: An experimental, randomized study was conducted in 42 adult individuals of both genders, submitted to elective urological surgeries, dividing the volunteers into two groups: 25 patients - Conventional fasting - (CF) and 17 patients - Abbreviated fasting - (AF), receiving the latter a 12.5% maltodextrin solution two h before the procedure. The glycemic curves of the patients in both groups were compared, and the demographic data of the sample studied. We also assessed thirst, hunger, nausea, vomiting, and patient satisfaction with the fasting time. The health professionals responded to a questionary to identify the factors limiting adherence to the abbreviated fasting protocol. A p-value <0.05 was considered statistically significant. Results: The average preoperative fasting time was 03:02 ± 01:04 hours and 12: 06 ± 01:15 hours in both AF and CF groups, respectively (p<0.01). There was greater satisfaction with the time of preoperative fasting in the AF group (p <0.01), in addition to less sensation of thirst (p <0.01) and post-operative hunger (p <0.04). There was no complication related to the abbreviation of fasting. There was a more significant increase in capillary glycemia in the CF group at 8 pm when compared to baseline at 10 pm (p <0.001). Of the 77 professionals interviewed, 68 (88%) were doctors, and 28 (36.4%) were unaware of the use of supplements, such as maltodextrin, in the preoperative period. Sixty-four (83%) reported not having an abbreviation fasting routine in their services. Forty responders (57%) considered the lack of knowledge on the topic as the main obstacle to the abbreviation of preoperative fasting. Conclusion: It is possible, even with some limitations, to institute an abbreviation routine for preoperative fasting in elective urological surgeries, safely and with favorable results. The incentive to training and continuing education of health professionals seems to be necessary measures to improve adherence to new concepts and promote changes in organizational culture.