Background:
Standardised perioperative fasting protocols have been developed to reduce the risk of massive pulmonary aspiration during surgery. The American Society of Anesthesiologists recommendation for 6-hour of pre-operative fasting was initially developed for well patients undergoing elective surgery, however this practice has been widely adopted for all cases including emergency procedures for major trauma and burns surgery. Prolonged fasting has been shown to be associated with mortality, infection and prolonged length of stay in major burns patients. We aimed to investigate whether reduced fasting times for major burns surgery were associated with increased perioperative complications.
Methods:
A review of recent literature relating to perioperative fasting times and major burns surgery was performed. Perioperative complications (including major aspiration), mortality, infection, and length of stay were the primary outcomes of this study.
Results:
Four studies were identified from recent literature relating to perioperative fasting protocols for major burns surgery amongst the ventilated population in specialised burns centres. Notably, no major aspiration events were recorded amongst a cohort of 17 continuously-fed patients undergoing a mean of seven operations per patient. All studies demonstrated increased adherence to nutritional goals amongst continuously-fed, or reduced-fasting patient populations.
Discussion:
Major burns and trauma populations demonstrate significantly increased metabolic demands. Recent literature suggests that standard perioperative fasting leads to an average loss of 50% of daily caloric requirements, with patients often requiring multiple operations in a short time frame. Safely reducing fasting time, or continuously feeding major burns patients is associated with reduced lag time to meeting caloric requirements with no increase in complications.
Conclusion:
Recent literature suggests that continuous enteral feeding in the ventilated major burns patient, may be safe throughout the perioperative period. Avoiding delays to feeding has been shown to reduce mortality and complications.