Preoperative fasting guidelines aim to prevent unnecessarily long fasting times whilst minimising the risk of gastric aspiration.[1] The current ANZCA guidelines has deemed ‘Sip Til Send’ (S2S) safe in patients over 16-years-old, allowing patients to have up to 200ml/hr.[1] 

Due to the difficulties in determining surgical start times, patients are often fasted for prolonged periods more than the timeframes listed above.[2] The introduction of S2S will help shorten liquid fasting times as there is often a time delay between when the patient is called for in theatre and the commencement of procedure. At Grampians Health–Ballarat, S2S has recently been implemented for adult patients scheduled for elective surgery. This audit aims to ascertain adherence to this new regimen, patient satisfaction and broadly identify changes to airway management and anaesthetic practice given the more liberal fluid fasting guidelines being implemented.

 

This has been approved as a Quality Assurance activity by the Grampians Health Research Ethics and Governance Office (Project ID: 108971).

All adult elective patients who participated in the S2S were offered the option to participate in a questionnaire assessing compliance and patient experience. Patient were asked when they were last offered a drink. Patient experience was assessed by asking the patient whether they feel happy with being given the option to drink against a three-point Likert scale.  In the second part of the questionnaire the anaesthetics team were asked whether they had changed their airway plan due to the patient participating S2S and if so, why. 

 

In the pilot week of introduction, 54% of eligible patient questionnaires were filled out. The lower questionnaire completion rate is due to the industrial action by Australian Nurses and Midwifery Federation, which has led to anaesthetics registrars and consultants filling out forms at short notice.*

On arrival to the anaesthetic bay, 75% of patients reported not being thirsty, 66% felt better being able to S2S and 70% of patients had either 200-400mls of clear fluids in the last 2 hours, with an average time since last sip being 42 minutes. 83% of the patients did not have a choice of clear fluids. One patient had more than 400mls, in contravention to the guidelines. No anaesthetic airway plans were changed due to S2S.

 

The implementation of S2S for adult elective patients at Grampians Health has significantly reduced clear fluid fasting times to <2 hours and most patients report feeling better being given the option to be able to drink. It was also noted that patients often did not receive a choice of clear fluid pre-operatively because the holding area did not get supplied with a variety of clear fluids, potentially hampering patient experience.

In conclusion, S2S at Grampians Health has had a positive impact on patient experience, though it requires more robust adoption with contribution from all involved staff members. A lack of awareness regarding the intricacies of this regimen has meant that by not offering a choice of fluid, this could have resulted in a reduction in otherwise intended fluid consumption. Excess fluid consumption in one patient may also represent a potential near-miss, as the risk of aspiration in that patient may have not have been recognised as being higher, particularly if they had other risk factors for aspiration.

 

 

1.Australian and New Zealand College of Anaesthetists.Guideline on pre-anaesthesia consultation and patient preparation Appendix 1 2023. 2024 Apr 11.Available from:https://www.anzca.edu.au/getattachment/897f5bf5-b665-4c99-a56f-e72678f19f7e/PG07(A)-Appendix-1-Fasting-guideline

2.Rüggeberg, A., & Nickel, E. A. (2022).Unrestricted drinking before surgery: an iterative quality improvement study.Anaesthesia,77(12),1386–1394.https://doi.org/10.1111/anae.15855