Indian Journal of Surgery

, Volume 80, Issue 6, pp 549–553 | Cite as

Preoperative Fasting and Patients’ Discomfort

  • Asiye GulEmail author
  • Isil Isik Andsoy
  • Birgul Ozkaya
Original Article


Excessive fasting times before surgery continue to be a widespread practice in Turkey. The aim of the study was to determine the relationship between traditional fasting policies and preoperative patient discomfort. Patients included were undergoing breast, hernia, thyroid, or abdominal operations at a general surgery clinic. Participants were classified as American Society of Anesthesiologists physical statuses I and II. A Likert-type scale was used to describe the effects of midnight fasting. Peripheral blood sugar and vital signs were measured immediately before induction of anesthesia. Of 164 participants, mean age was 53.56 ± 13.47 years. Mean preoperative fasting times were 13.34 ± 3.07 h for solids and 12.44 ± 2.82 h for fluids. Immediately before surgery, 6.1% of patients were extremely thirsty, 5.5% were hungry, and 39% had mild dryness of the mouth. There was a weak positive correlation between total duration of solid fasting and thirst, hunger, mouth dryness, and weakness immediately preoperatively. Prolonged fasting before surgery was associated with patients’ discomfort. Current evidence-based guidelines for preoperative fasting may improve patients’ satisfaction.


Adult Fasting Preoperative Surgery 



The manuscript has been read and approved by all authors and that all authors agree to the submission of the manuscript. All authors must have agreed on the final version of the paper and must meet at least one of the commended by the International Council of Medical Journal Editors criteria.

Compliance with Ethical Standards

The institutional review board approved the study protocol (BEAH: 2013-06).

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Bopp C, Hoper S, Klein A, Weigand MA, Martin E, Gust R (2011) A liberal preoperative fasting regimen improves patient comfort and satisfaction with anesthesia care in day-stay minor surgery. Minerva Anestesiol 77:680–686Google Scholar
  2. 2.
    Ludwig RB, Paluda J, Fernandes D, Scherer F (2013) Lesser time of preoperative fasting and early postoperative feeding are safe. Arg Bras Cir dig 26:54–58CrossRefGoogle Scholar
  3. 3.
    Manchikanti L, Malla Y, Wargo BW, Fellows B (2011) Preoperative fasting before interventional techniques: is it necessary or evidence-based. Pain Physician 14:459–467Google Scholar
  4. 4.
    Lambert E, Carey S (2015) Practice guideline recommendation on perioperative fasting: a systematic review. J Parenter Enteral NutrGoogle Scholar
  5. 5.
    Gül A, Andsoy II, Üstündağ H, Özkaya BÖ (2013) Assessment of preoperative fasting time in elective general surgery. The Journal of Macro Trends in Health and Medicine 1:1–8Google Scholar
  6. 6.
    Khoyratty S, Modi BN, Ravichandran D (2010) Preoperative starvation in elective general surgery. J Perioper Pract 20:100–102CrossRefGoogle Scholar
  7. 7.
    Power S, Kavangh DO, McConnell G, Cronin K, Corish C, Leonard M, Crean A, Feehan S, Eguare E, Neary P, Connolly J (2012) Reducing preoperative fasting in elective adult surgical patients: a case-control study. Ir J med Sci 181:99–104CrossRefGoogle Scholar
  8. 8.
    de Andrade Gagheggi Ravanini G, Portari Filho PE, Abrantes Luna R, Almeida de Oliveira V (2015) Organic inflammatory response to reduced preoperative fasting time, with a carbohydrate and protein enriched solution; a randomized trial. Nutr Hosp 32(2):953–957Google Scholar
  9. 9.
    Hamid S (2014) Pre-operative fasting a patient centered approach. BMJ Qual Improv Report 23:1–4Google Scholar
  10. 10.
    Gemremedhn EG, Nagaratnam VB (2014) Audit on preoperative fasting of elective surgical patients in an African Academic Medical Center. World J Surg 38:2200–2204CrossRefGoogle Scholar
  11. 11.
    Tosun B, Yava A, Açıkel C (2015) Evaluating the effects of preoperative fasting and fluid limitation. Int J Nurs Pract 21:1156–1165CrossRefGoogle Scholar
  12. 12.
    Falconer R, Skouras C, Carter T, Greenway L, Paisley AM (2014) Preoperative fasting: current practice and areas for improvement. Updat Surg 66(1):31–39CrossRefGoogle Scholar
  13. 13.
    de Aguilar-Nascimento JE, de Almeida Dias AL, Dock-Nascimento DB, Correia MITD, Campos ACL, Portari-Filho PE, Oliveira SS (2014) Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study. Ther Clin Risk Manag 10:107–112Google Scholar
  14. 14.
    Roberts S (2013) Preoperative fasting: a clinical audit. J Perioper Pract 23(1–2):11–16CrossRefGoogle Scholar
  15. 15.
    Dolgun E, Taşdemir N, Ter N, Yavuz M (2011) Investigation of preoperative fasting times of surgical patients. Fırat University Medical Journal of Health Sciences 25:11–15Google Scholar
  16. 16.
    Aroni P, do Nascimento LA, Fonseca LF (2012) Assessment strategies for the management of thirst in the post-anesthetic recovery room. Acta Paul Enferm 25:530–536CrossRefGoogle Scholar
  17. 17.
    Karadağ M, Pekinİşeri Ö (2014) Determining health personnel’s application trends of new guidelines for preoperative fasting: findings from a survey. J Peri Anesth Nurs 29:175–184CrossRefGoogle Scholar
  18. 18.
    Lim HJ, Lee H, Ti LK (2014) An audit of preoperative fasting compliance at a major tertiary referral hospital in Singapore. Singap med J 55(1):18–23CrossRefGoogle Scholar
  19. 19.
    Crenshaw JT (2011) Preoperative fasting: will the evidence ever be put into practice. Am J Nurse 111(10):38–43Google Scholar
  20. 20.
    Andrew-Romit JJ, van de Mortel TF (2011) Ritualistic preoperative fasting: is it still occurring and what can we do about it. The Journal of Perioperative Nursing in Australia 24(1):14–19Google Scholar
  21. 21.
    Bower WF, Lee PY, Kong AP, Jiang JY, Underwood MJ, Chan JC, van Hasselt CA (2010) Peri-operative hyperglycemia: a consideration for general surgery. Am J Surg 199(2):240–248CrossRefGoogle Scholar
  22. 22.
    Mannix T (2014) Nil by mouth: best practice and patient education. Nurs Times 110(26):12–14Google Scholar
  23. 23.
    BMI classification. Report of a World Health Organization. Global database on body mass index. Accessed 24 Nov 2015
  24. 24.
    Gunawardhana AI (2012) Knowledge, attitudes and practice of preoperative fasting guidelines in the National Hospital of Sri Lanka. Sri Lankan Journal of Anesthesiology 20:92–95CrossRefGoogle Scholar
  25. 25.
    Bothamley J, Mardell A (2005) Preoperative fasting revisited. Br J Perioper Nurs 15:370–374Google Scholar
  26. 26.
    Salman OH, Asida SM, Ali HS (2013) Current knowledge, practice and attitude of preoperative fasting: a limited survey among Upper Egypt anesthetists. Egyptian Journal of Anaesthesia 29:125–130CrossRefGoogle Scholar
  27. 27.
    Melnyk M, Casey RG, Black P, Koupparis AJ (2011) Enhanced recovery after surgery (ERAS) protocols: time to change practice. Can Ural Assoc J 5(5):342–348CrossRefGoogle Scholar
  28. 28.
    Protic A, Turina D, Matanic D, Spanjol J, Zuvic-Butorac M, Sustic A (2010) Effect of preoperative feeding on gastric emptying following spinal anesthesia: a randomized controlled trial. Wien Klin Wochenschr 122:50–53CrossRefGoogle Scholar
  29. 29.
    Liddle C (2014) Nil by mouth: best practice patient education. Nurs Times 110(26):12–14Google Scholar

Copyright information

© Association of Surgeons of India 2017

Authors and Affiliations

  1. 1.Faculty of Health ScienceUniversity of Health ScienceIstanbulTurkey
  2. 2.Faculty of Health ScienceKarabuk UniversityKarabukTurkey
  3. 3.General Surgery UnitDr. Sadi Konuk Training and Research HospitalBakirkoyTurkey

Personalised recommendations