Journal of Clinical Anesthesia (2015) xx, xxx–xxx
Correspondence The chewing gum controversy—time for a consensus? We read with interest the meta-analysis by Ouanes et al [1] reviewing the role of perioperative chewing gum on gastric fluid volume and gastric pH. It is reassuring to find that although chewing gum preoperatively may cause small increases in gastric fluid volumes (MD = 0.21 mL/kg, P = .03) with no change in gastric pH, that this is most likely to carry no significant risk of clinical aspiration. Despite these conclusions, it is disappointing that currently, there is a vast difference in clinical practice for managing those patients who have chewed gum ranging from proceeding without delay [2], waiting 2 hours [3] or assuming that chewing gum is a solid foodstuff and waiting 6 hours [4]. One solution to improving patient satisfaction, clinician consistency, and theater utilization would be the publication of a consensus working party statement regarding the chewing of gum, tobacco, and the sucking of boiled sweets. This would be similar to the landmark American Society of Anesthesiologists' article on shortened fasting times [5] and would ensure that patients are given the correct information before admission to hospital for elective surgery.
☆
No external funding and no competing interests declared.
0952-8180/© 2015 Elsevier Inc. All rights reserved.
N. Jain MBChB, FRCA* S. Mercer MBChB, MAcadMEd, FHEA, FCollT, FRCA, MMEd Aintree University Hospital, Liverpool, UK ⁎Corresponding author E-mail address: [email protected] http://dx.doi.org/10.1016/j.jclinane.2015.05.009
References [1] Ouanes, et al. The role of perioperative chewing gum on gastric fluid volume and gastric pH: a meta-analysis. J Clin Anesth 2015;27:146-52. [2] Smith, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2011;28:556-69. [3] Verma, et al. Preoperative assessment and patient preparation: the role of the anaesthetist 2. London: Association of Anaesthetists of Great Britain and Ireland; 2010[AAGBI Safety Guideline; 2. http://www.aagbi.org/ sites/default/files/preop2010.pdf. (accessed 14th April 2015)]. [4] Perioperative fasting in adults and children—a RCN guideline for the multidisciplinary team. Clinical practice guidelines, RCN publications; 2005 [http://www.rcn.org.uk/__data/assets/pdf_file/0009/78678/ 002800.pdf. (accessed 14th April 2015)]. [5] American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology 2011;114:495-511.
Correspondence The chewing gum controversy—time for a consensus? We read with interest the meta-analysis by Ouanes et al [1] reviewing the role of perioperative chewing gum on gastric fluid volume and gastric pH. It is reassuring to find that although chewing gum preoperatively may cause small increases in gastric fluid volumes (MD = 0.21 mL/kg, P = .03) with no change in gastric pH, that this is most likely to carry no significant risk of clinical aspiration. Despite these conclusions, it is disappointing that currently, there is a vast difference in clinical practice for managing those patients who have chewed gum ranging from proceeding without delay [2], waiting 2 hours [3] or assuming that chewing gum is a solid foodstuff and waiting 6 hours [4]. One solution to improving patient satisfaction, clinician consistency, and theater utilization would be the publication of a consensus working party statement regarding the chewing of gum, tobacco, and the sucking of boiled sweets. This would be similar to the landmark American Society of Anesthesiologists' article on shortened fasting times [5] and would ensure that patients are given the correct information before admission to hospital for elective surgery.
☆
No external funding and no competing interests declared.
0952-8180/© 2015 Elsevier Inc. All rights reserved.
N. Jain MBChB, FRCA* S. Mercer MBChB, MAcadMEd, FHEA, FCollT, FRCA, MMEd Aintree University Hospital, Liverpool, UK ⁎Corresponding author E-mail address: [email protected] http://dx.doi.org/10.1016/j.jclinane.2015.05.009
References [1] Ouanes, et al. The role of perioperative chewing gum on gastric fluid volume and gastric pH: a meta-analysis. J Clin Anesth 2015;27:146-52. [2] Smith, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2011;28:556-69. [3] Verma, et al. Preoperative assessment and patient preparation: the role of the anaesthetist 2. London: Association of Anaesthetists of Great Britain and Ireland; 2010[AAGBI Safety Guideline; 2. http://www.aagbi.org/ sites/default/files/preop2010.pdf. (accessed 14th April 2015)]. [4] Perioperative fasting in adults and children—a RCN guideline for the multidisciplinary team. Clinical practice guidelines, RCN publications; 2005 [http://www.rcn.org.uk/__data/assets/pdf_file/0009/78678/ 002800.pdf. (accessed 14th April 2015)]. [5] American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology 2011;114:495-511.
