Dear Dr. Roach: Questioning the “no eating after midnight before surgery” rule | Bless you


DR. KEITH ROACH For the Herald & Review

DEAR DOCTOR. ROACH: Why, no matter what time an operation is scheduled, does “no eating or drinking after midnight” apply? My last procedure was scheduled for 12.30 p.m. I was told that I couldn’t eat anything after midnight. My procedure took two hours and recovery took two hours. That’s over 16 hours without food! When I told the planner that I was going to have a headache from 16 hours without food, I was told that was the guideline. Period. No food after midnight. “Besides,” she said, “they’ll give you something to eat to help you recover.”

I’m sorry, but a cup-sized drink with juice and a couple of crackers won’t work. Until then it will be too late. And as it happened, they didn’t give me anything to recover anyway. I ate when I got home, but I was sick for hours. If my surgery had been scheduled for 6 a.m., it would have been 10 hours with no food. 16 hours at noon without food. And so forth. Why the one-size-fits-all policy? The cutoff time for food intake should be coordinated with the time of the operation. Maybe midnight is just an easy time to remember.

A: I agree with you that 16 hours without food is both cruel and unnecessary and can actually lead to harm, such as: B. increased postoperative nausea and vomiting. Even 10 hours is longer than necessary. The American Society of Anesthesiologists, like most professional societies, recommends that adults avoid heavy foods (including fat and meat) eight hours before surgery; Fasting solid foods or milk for six hours before surgery; and fasting from clear liquids two hours before surgery.

In your case, with an operation scheduled at 12.30 p.m., you could certainly have got up early (e.g. at 6 a.m.) and had a light breakfast; then water, black coffee or tea was allowed until 10:30 a.m. I can’t tell you why your operations center was so dogmatic.

Of course, some individuals may have health problems that require longer fasts. So ask your surgeon or anesthetist what you can eat and when.

DEAR DOCTOR. ROACH: My recent echocardiogram showed I had 50% heart function, which my doctor called “low normal”. I’m a 74-year-old male who works out on a treadmill two to three times a week and spends 45 minutes on 4.2 miles at 3.5 mph. Can exercise increase heart function or is it gone once it’s gone?

A: The ejection fraction is a single measurement of cardiac function taken through an echocardiogram. It measures the amount of blood expelled from the left ventricle during each cardiac cycle. The normal range is 50-75%, but 75% is not necessarily better. A very high fraction of ejection is not normal. A low fraction of ejection is common: around 12% of people have an EF below 54%. A value below 45% is usually associated with symptoms of heart failure. However, elite athletes often have low normal to normal ejection fractions.

More important than any heart measurement is how much you can do. You work out pretty well. As you increase your speed, you will likely gradually get used to the higher speed as your heart function improves. Exercise can improve heart function in almost everyone.

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