A national survey on preoperative fasting policies and practices in Jamaican hospitals

Controversy has arisen regarding the length and nature of the preoperative fast that should be required of patients with normal gastric emptying time undergoing elective surgery. Various studies and editorials have indicated that the traditional preoperative fasting policy of "NPO after midnight" may be illogical as it makes no distinction between solid foods and clear fluids. Successive National Surveys conducted in the United States of America (USA) have shown an increasing number of Ambulatory Surgery Hospitals adopting more liberal preoperative fasting guidelines. Jamaican practitioners have also begun implementing some of these new liberal practices, even in institutions where "NPO after midnight" remain the official policy of the institution in which they practice. This has created a discordance between individual practice and institutional policy. In view of the fact that the extent of this discrepancy has not yet been studied and documented in Jamaica, and in an effort to better characterize the nature of the changes taking place in preoperative fasting practices in Jamaican hospitals, including those related to knowledge and attitude of practitioners, we embarked on this National Survey. The survey consisted of a questionnaire comprised of 13 questions which were to be completed by all surgeons and anaesthetists practising in a wide cross-section of public hospitals throughout Jamaica, providing an initial sample size of 201 subjects. We had a response rate of 74%, or 148 responses. At all the hospitals surveyed, the traditional NPO policy continued to be the official institutional policy. However, at the individual level, 37% of respondents had already revised their policy, and were allowing their patients to have clear fluids up to three hours before the induction of anaesthesia. Also, 66%, 68%, and 73% of respondents stated that, in the future, they were prepared to allow their patients a solid meal up to eight hours, light breakfast up to six hours, and clear fluids up to three hours, respectively. We concluded that, whilst the traditional NPO policy remained firmly entrenched at the institutional level, many anaesthetists and surgeons show a positive inclination towards more liberal fasting practices. We recommend the formation of a local task force to determine what aspects of the new, liberal guidelines may be safely and effectively adopted,, taking account of local circumstances.