Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.10.019
Brazilian Journal of Anesthesiology
Scientific Article

Reduced fasting time improves comfort and satisfaction of elderly patients undergoing anesthesia for hip fracture

A diminuição do tempo de jejum melhora o conforto e satisfação com anestesia em pacientes idosos com fratura de quadril

Luiz Eduardo Imbelloni; Illova Anaya Nasiane Pombo; Geraldo Borges de Morais Filho

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Abstract

BACKGROUND AND OBJECTIVES: Patient's satisfaction is a standard indicator of care quality. The aim of this study was to evaluate whether a preoperative oral ingestion of 200 mL of a carbohydrate drink can improve comfort and satisfaction with anesthesia in elderly patients with hip fracture. METHOD: Prospective randomized clinical trial conducted in a Brazilian public hospital, with patients ASA I-III undergoing surgery for hip fracture. The control group (NPO) received nothing by mouth after 9:00 p.m. the night before, while patients in the experimental group (CHO) received 200 mL of a carbohydrate drink 2-4 h before the operation. Patients' characteristics, subjective perceptions, thirst and hunger and satisfaction were determined in four steps. Mann-Whitney U-test and Fisher exact test were used for comparison of control and experimental groups. Ap-value <0.05 was considered significant. RESULTS: A total of 100 patients were included in one of the two regimens of preoperative fasting. Fasting time decreased significantly in the study group. Patients drank 200 mL 2:59 h before surgery and showed no hunger (p < 0.00) and thirst on arrival to OR (p < 0.00), resulting in increased satisfaction with the perioperative anesthesia care (p < 0.00). CONCLUSIONS: The satisfaction questionnaire for surgical patient could become a useful tool in assessing the quality of care. In conclusion, CHO significantly reduces preoperative discomfort and increases satisfaction with anesthesia care.

Keywords

Spinal anesthesia, Fasting, Satisfaction

Resumo

JUSTIFICATIVA E OBJETIVOS: A satisfação do paciente é indicador padrão da qualidade da assistência prestada. O objetivo deste estudo foi avaliar se a ingestão de 200 mL oral pré-operatória de uma bebida de carboidratos pode melhorar o conforto e a satisfação com a anestesia no paciente idoso com fratura de quadril. MÉTODO: Ensaio clínico prospectivo e randomizado realizado em hospital público de saúde brasileiro, pacientes estado físico ASA I-III submetidos à cirurgia de fratura de quadril. O grupo controle (NPO) não recebeu nada pela boca, após as 21 horas da noite anterior, enquanto que os pacientes no grupo experimental (CHO) recebeu 200 mL de uma bebida de carbohidratos de 2 a 4 horas antes da operação. Características dos pacientes, percepções subjetivas, presença de sede e fome e satisfação dos pacientes foi apurado em quatro etapas. Teste de Mann-Whitney U-test e exato de Fisher foram utilizados entre o grupo controle e o grupo experimental. Valor de p < 0,05 foi considerado significativo. RESULTADOS: Um total de 100 pacientes foram incluídos em um dos dois regimes de jejum pré-operatório. Tempo de jejum diminuiu significativamente no grupo de estudo. Pacientes beberam 200 mL 2:59 h antes da cirurgia e não apresentaram fome (p < 0,00) e sede na chegada à SO (p < 0,00), resultando em aumento da satisfação com o cuidado perioperatório anestesia (p < 0,00). CONCLUSÕES: O questionário de satisfação do paciente cirúrgico poderia tornar-se um instrumento útil na avaliação da qualidade de atendimento. Em conclusão, CHO reduz significativamente o desconforto pré-operatório e satisfação com os cuidados da anestesia.

Palavras-chave

Raquianestesia, Jejum, Satisfação

References

Linn MW, Linn BS, Stein SR. Satisfaction with ambulatory care and compliance in older patients. Med Care.. 1982;20:606-14.

Kincey J, Bradshaw P, Ley P. Patient's satisfaction and reported acceptance of advice in general practice. J R Coll Gen Pract.. 1975;25:558-66.

Young GJ, Meterko M, Desal KR. Patient satisfaction with hospital care. Med Care.. 2000;38:325-34.

Lewis SJ, Egger M, Sylvester PA. Early enteral feeding versus ''nil by mouth'' after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. Br Med J.. 2001;323:1-5.

Oliveira KGB, Balsan M, Oliveira SS. Does abbreviation of preoperative fasting to two hours with carbohydrates increase the anesthetic risk?. Rev Bras Anestesiol.. 2009;59:577-84.

Hausel J, Nygren J, Lagerkranser M. A carbohydraterich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg.. 2001;93:1344-50.

Hausel J, Nygren J, Thorell A. Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. Br J Surg.. 2005;92:415-21.

Bollam MJ, McCarthy M, Modell M. Patient's assessment of out of hours care in general practice. Br Med J.. 1988;296:829-32.

Morrell DC, Evan ME, Morris RW. The five minute consultation: effect of time constraint on clinical content and patient satisfaction. Br Med J.. 1986;292:870-3.

Kaim-Caudle PR, Marsh GN. Patient satisfaction survey in general practice. Br Med J.. 1975;1:262-4.

Davidoff LL. Introdução à Psicologia. 2001:559.

Angerami-Camon VA, Trucharte FAR, Knijnik RB. Psicologia Hospitalar - Teoria e Prática. Cengage Learn.. 2010;27:34.

Koval KJ, Maurer SG, Su ET. The effects of nutritional status on outcome after hip fracture. J Orthop Trauma.. 1999;13:164-9.

Goldacre MJ, Roberts SE, Yeates D. Mortality after admission to hospital with fractured neck of femur: database study. Br Med J.. 2002;325:868-9.

Parker M, Johasen A. Hip fracture. Br Med J.. 2006;333:27-30.

Morrison RS, Chassin MR, Siu AL. The medical consultant's role in caring for patients with hip fracture. Ann Intern Med.. 1998;128:1010-20.

Waitzberg DL, Caiaffa WT, Correia MITD. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition.. 2001;17:573-80.

Lipschitz DA. Screening for nutritional status in the elderly. Prim Care.. 1994;21:55-67.

Cervi A, Franceschini SCC, Priore SE. Análise crítica do uso do índice de massa corporal para idosos. Rev Nutr Campinas.. 2005;18:765-75.

Aguilar-Nascimento JE, Salomão AB, Caporossi C. Acerto pós-operatório: avaliação dos resultados da implantação de um protocolo multidisciplinar de cuidados peri-operatórios em cirurgia geral. Rev Col Bras Cir.. 2006;33:181-7.

Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003:CD0004423.

Kindler CH, Harms C, Amsler F. The visual analog scale allows effective measurement of preoperative anxiety and detection of patients' anesthetic concerns. Anesth Analg.. 2000;90:706-12.

Feguri GR, Lima PRL, Lopes AM. Clinical and metabolic results of fasting abbreviation with carbohydrates in coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc.. 2012;27:7-17.

Breuer JP, von Dossow V, von Heymann C. Preoperative oral carbohydrate administration to ASA III-IV patients undergoing elective cardiac surgery. Anesth Analg.. 2006;103:1099-108.

Carr DB, Goudas LC. Acute pain. Lancet.. 1999;353:2051-8.

Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg.. 2002;183:630-44.

Aroni P, Nascimento LA, Fonseca LF. Assessment strategies for the management of thirst in the post-anesthetic recovery room. Acta Paul Enferm.. 2012;25:530-6.

Crenshaw JT, Winslow EH. Preoperative fasting: old habits die hard. AJN Am J Nurs.. 2002;102:37-44.

Oliver RL. Cognitive, affective, and attribute bases of the satisfaction response. J Consum Res.. 1993;20:418-30.

Churchill GA Jr, Surprenant C. An investigation into the determinants of customer satisfaction. J Mark Res.. 1982;19:491-504.

Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q.. 1996;44:166-203.

Doering ER. Factors influencing inpatient satisfaction with care. QRB Qual Rev Bull.. 1983;9:291-9.

Meisner M, Ernhofer U, Schmidit J. Liberalisation of preoperative fasting guidelines: effects on patient comfort and clinical practicability during elective laparoscopic surgery of the lower abdomen. Zentralbl Chir.. 2008;133:479-85.

Imbelloni LE, Beato L, Beato C. Analgesia pós-operatória para procedimentos cirúrgicos ortopédicos de quadril e fêmur: Comparação entre bloqueio do compartimento do psoas e bloqueio perivascular inguinal. Rev Bras Anestesiol.. 1982;56:619-29.

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