PLD.04 Audit of Adherence to Antacid and Fasting Guidelines for Elective Caesarean Section at the Royal Victoria Infirmary, Newcastle upon Tyne

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Abstract

Aims

To audit current practice regarding concordance with RCN fasting guidelines (6 h for solids and 2 h for clear fluids) (endorsed by RCoA and RCoM) and reference to antacid prophylaxis in the NICE guideline for caesarean section.

Background

Elective CS under regional anaesthesia carries a 1% risk of conversion to general anaesthesia. Pre-operative fasting and antacid prophylaxis guidelines aim to reduce the risk of maternal pulmonary aspiration associated with general anaesthesia. RCN guidelines state that women should be encouraged to consume clear fluids 2 h prior to surgery.

Materials and Methods

Data was collected using a proforma, detailing; the anaesthetic (type, time delivered), antacid (whether taken, type), fasting (solid /clear fluid, how long patient told to fast for, how information was delivered), patients’ feeling of hunger and thirst before operation, and whether low urine output delayed recovery.

Results

100% mothers surveyed (36) followed fasting and antacid prophylaxis guidelines. The mean time without solids was 14 hours (range 9–24 hours) and without clear fluids was 12 hours (3–17 hours). 94% of mothers reported receiving written Trust fasting instruction. 0% of mothers drank clear fluids around 2 h before delivery of their anaesthetic. Low urine output delayed recovery in 12 patients.

Conclusions

Mothers follow guidelines; however current Trust patient information, which state “nil by mouth from midnight”, is not in line RCN guidelines. Patient information should be changed in line with these guidelines, emphasising consumption of clear fluids the morning of surgery.

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