starvation periods

RE: starvation periods

Vicky Ford-Fennah — Wed, 10 May 2017 08:51:54 GMT

Hi Fiona,

You are correct about the type of food being really important, as it effects gastric volume and emptying greatly. If you look earlier at my replies to the post there is a link to one research paper, but this group in Greece has done a whole series of different studies so they contain all the info you require (or ref other papers which contain the info). I would be quite concerned if a patient had been fed even a small amount of dry food at 6am and was given pre-mend at 9am (we would delay the elective procedure).

Hope that's helpful, just shout if you need any other info

Vicky Ford-Fennah

BSc(Hons) RVN VTS(anesthesia/analgesia) A1 VPAC

Nurse/technician Rep Association of Veterinary Anaesthetists

RE: starvation periods

fiona eldridge — Wed, 10 May 2017 08:03:16 GMT

[quote user="Courtney Scales"]

Hi Fay - the 2016 BSAVA on Canine and Feline Anaesthesia and Analgesia suggests a fasting time of 6-8 hours of food and 2-4 hours of water prior to the administration of a premedication. Prolonged fasting can decrease gastric pH (acidic) and increase the likelihood of reflux. Are you seeing this?

I think with your clinics prolonged time of no food will increase length of recovery (hypoglycemia, dehydration and general lack of food happiness!). Those senior patients and really young patients will be the ones suffering the most. Are your patients on IVFT routinely?

Who is the main food supplier in your practice? Maybe they will offer post surgery tins/pouches for patients - not unheard of!

[/quote]

im currently reviewing this thread with great interest. My current practice have just introduced the new protocol of feeding all dogs and cats at 6am on the day of surgery After cod from a veterinary anaesthesia specialist?.... I'm just trying to research why as at our branch practice we try to do surgeries early doors at 9-10am. This not providing a 6-8hr fast which worries me. i don't have the bsava anaesthesia book any chance anyone could pm me a photo of the legislation or help at all? Also clients aren't advised as to type of food.. only they can feed light breakfast...... as of this paper my understanding is wet breakfast is better... any papers or written word of this would be a great help. Thanks

RE: starvation periods

Meow1950 — Thu, 13 Apr 2017 21:37:43 GMT

[quote user="NickyVN"]

We feed most of ours as soon as awake enough and don't ever recall one vomiting. With our young patients we give them a small meal at 7ish on the morning of surgery and again no problems.

[/quote]

So just a small amount of a gastrointestinal diet do you recommend?

Will certainly give this a try!

RE: starvation periods

Nicola Smith — Thu, 13 Apr 2017 20:44:00 GMT

We feed most of ours as soon as awake enough and don't ever recall one vomiting. With our young patients we give them a small meal at 7ish on the morning of surgery and again no problems.

RE: starvation periods

Meow1950 — Thu, 13 Apr 2017 18:50:05 GMT

We say from 8pm night before in my practice but I think this is very long, considering by the time they're admitted, pre-med, knocked etc. Especially on cats who are technicly little and often eaters! I'm torn about the feed post-op because I'm always worried about them vomiting before home and me getting a telling off about it from the boss lol but I take it other people don't experience this problem?

RE: starvation periods

Vicky Ford-Fennah — Tue, 11 Apr 2017 10:44:27 GMT

You could try asking owners to give an "evening supper" just before bed the night before (not leaving the food down just in case they don't eat it). Don't get clients to withhold water. Even if the feeding interval is reduced it's likely to help with gastric pH changes. This is your main concern in patients that do not have diabetes, liver dx or any condition that has resulted in poor body condition.

Vicky Ford-Fennah

BSc(Hons) RVN VTS(anaesthesia/analgesia) A1 VPAC

Nurse Representative Association of Veterinary Anaesthetists

RE: starvation periods

Sal the 1st — Tue, 11 Apr 2017 08:03:29 GMT

well the first thing I can see from that if money is a concern is ditch the i/v fluids unless they are genuinely needed and feed day patients before they go home. Trial it for a week and notice the difference

RE: starvation periods

Fay Cavanagh — Mon, 10 Apr 2017 22:18:29 GMT

Thanx for this. All clients are offered bloods, IVFT and a wet diet for use at home post GA but we all know clients don't like to spend extra money of they cannot see the benefot to it. My concern was that a lot of cats / dogs have beenough starved since 5pm ish the night prior to their GA and often wount be offered anything until at least 4pm the follow day. I was hoping to change some protcols within the practice but needed 'evidence' that shows cahnges would be beneficial to the patient

RE: starvation periods

Courtney Scales — Sat, 08 Apr 2017 20:14:49 GMT

Gaaah hahaha YES! Even my brain knows that, my hands go on autopilot typing. I will edit my post :D

RE: starvation periods

Vicky Ford-Fennah — Sat, 08 Apr 2017 20:10:33 GMT

Hi Courtney, pH reduces( more acidic) as length of starvation increases

RE: starvation periods

Courtney Scales — Sat, 08 Apr 2017 20:02:56 GMT

RE: starvation periods

Sal the 1st — Fri, 07 Apr 2017 23:43:38 GMT

[quote user="Vicky Ford-Fennah"]

A study published in 2009 showed that in dogs feeding half the daily requirement of a canned food 3hrs before anaesthesia significantly increased gastric pH and didn't result in an increase gastric content. These two findings are significant because increased gastric content is going to increase the risk or regurgitation and possibly impact respiratory function under GA. The high pH really important as if gastric reflux does occur (even if silent - just oesophageal and not entering the oral cavity) the lower the pH the more damage the reflux is likely to do. It is important that it is canned not dry food if this starving period is used. The paper explains a lot of the issues behind reflux and effect different feed regimes have. This link has the details of the paper https://www.ncbi.nlm.nih.gov/pubmed/19845925

As for post-operative feeding, patients should be fed as soon as they are fully recovered, with a small amount of highly digestible wet food, if this is tolerate then the patient can be given more. As for the cost to the practice it needs to be charged to the client.

Hope that is helpful

Vicky Ford-Fennah

BSc(Hons) RVN VTS(anesthesi/analgesia) A1 VPAC

Nurse/technician Rep Association of Veterinary Anaesthetists

[/quote]

- I knew the reason why we told our clients this but I just couldn't find the paper evidence to back up why we said it I know especially with our geriatric, skinny cats we don't with hold food for more than a few hours, have never had a problem with this but I know this is a bit controversial to some

RE: starvation periods

Vicky Ford-Fennah — Fri, 07 Apr 2017 20:29:55 GMT

Hope that is helpful

Vicky Ford-Fennah

BSc(Hons) RVN VTS(anesthesia/analgesia) A1 VPAC

Nurse/technician Rep Association of Veterinary Anaesthetists

RE: starvation periods

James Colver Cert. Ed, RVN — Thu, 06 Apr 2017 21:39:35 GMT

[quote user="jojofruits"]

Wow. Get them to put 50p on the price of the hospitalisation and feed them! This is awful! Not. Ok!

[/quote]

Completely agree. I think that the historical "10pm the night before" protocol has been shown to be a little excessive in terms of how long the stomach takes to empty, and that it could be reduced somewhat accordingly - but far more important is feeding appropriately on recovery.

RE: starvation periods

Sal the 1st — Wed, 05 Apr 2017 19:45:44 GMT

all our inpatients are fed as soon as they are awake enough to eat. We ask on admission or before if they have any food allergies etc - if the don't then its select protein cat or dog if they do and we are aware of it we ask that the client brings in what they would normally eat. Rabbits and small furries we always ask that they bring in some of their normal food so that we know they are eating before they go home (and I don't care too much if its muesli rather than excel or others I just want the rabbit to eat) - I once watched a nurse dressing down a client in a waiting room because the client had brought in muesli mix for her rabbit that was in for neuter, I was a locum there so couldn't say too much - but there is a time and a place and timing could not have been worse for a client who was bringing in her pet for surgery and was already anxious and place in front of other clients in the waiting room? - well it was hardly going to establish rapport was it

RE: starvation periods

jojofruits — Wed, 05 Apr 2017 16:12:33 GMT

Wow. Get them to put 50p on the price of the hospitalisation and feed them! This is awful! Not. Ok!

RE: starvation periods

melanie lavender — Wed, 05 Apr 2017 15:56:58 GMT

At my practice we starve from 8pm the night before and surgerys start at 10am.

"better the devil you know"

"if it an't broke don't fix it"

RE: starvation periods

Nicola Smith — Wed, 05 Apr 2017 12:45:32 GMT

Or why not ask clients to bring some food with them?

RE: starvation periods

Alison Clare Hickman — Wed, 05 Apr 2017 11:44:05 GMT

Hi,

Just a thought for your practice to consider... why not ask at Admission if client wants to buy (minimum) of one tin of e.g. Recovery food so that their pet can have something to eat?! Anything left can go home with them (we use a latex glove over the top of the opened tin). Will also help practice pocket!

Ali h