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COMMENTS ON PUBLISHED ARTICLE
Year : 2020  |  Volume : 64  |  Issue : 10  |  Page : 923-924  

Perioperative Fasting Guidelines- No oral intake upto 8 hours after caeserean section?


Department of Anaesthesia, Kokilaben Ambani Hospital, Mumbai, Maharashtra, India

Date of Submission02-Jul-2020
Date of Decision25-Jul-2020
Date of Acceptance02-Aug-2020
Date of Web Publication1-Oct-2020

Correspondence Address:
Harshal D Wagh
Department of Anaesthesia, Kokilaben Ambani Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_878_20

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How to cite this article:
Wagh HD. Perioperative Fasting Guidelines- No oral intake upto 8 hours after caeserean section?. Indian J Anaesth 2020;64:923-4

How to cite this URL:
Wagh HD. Perioperative Fasting Guidelines- No oral intake upto 8 hours after caeserean section?. Indian J Anaesth [serial online] 2020 [cited 2020 Oct 20];64:923-4. Available from: https://www.ijaweb.org/text.asp?2020/64/10/923/296991



Sir,

I read with great interest “Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists” by Dr Dongare et al.[1] I would like to congratulate the authors for such a comprehensive analysis of a very important and relevant topic.

However, I would like to express my difference of opinion about the recommendations of the authors of not allowing even water or clear fluids for up to 8 h in obstetric patients after an uncomplicated caesarean section done under any type of anaesthesia. I would like to highlight our small case study wherein we raise the question about the need to keep our caesarean patients starving too much postoperatively. In the 100 patients included in our study, early oral intake after caesarean section regardless of objective signs of the return of bowel functions was demonstrated to be safe and effective, with added patient comfort as the primary benefit.[2] All the patients included in the study had clear fluids within 2 h and a soft diet with 4 h after the surgery was done.

As mentioned in the parent article, Kathpalia found in his pilot study that there is no justification to withholding oral feeds as is traditionally done. Early feeding should be initiated without any fear of side effects. Patients have early postoperative recovery; it is cost effective and results in higher patient satisfaction.[3]

National Institute for Health and Care Excellence (NICE) UK has clearly mentioned in its updated guidelines in 2019 that women who are recovering well after caesarian section and who do not have complications can eat and drink when they feel hungry or thirsty.[4]

Therefore, after taking into consideration enhanced recovery after surgery (ERAS) and NICE guidelines, it would be harsh not to allow any oral intake in post-caesarean section patients, as long as there is no medical and surgical indication to do so and the patient is fully awake and has regained all upper airway reflexes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
DongarePA, BhaskarSB, HarsoorSS, Garg R, Kannan S, Goneppanavar U, et al. Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice guidelines from the Indian society of anaesthesiologists. Indian J Anaesth 2020;64:556-84.  Back to cited text no. 1
    
2.
Sathe K, Wagh H, Kakde A, Thusay P. Are we starving our cesarean patients too much postoperatively? J Anaesth Crit Care Case Rep 2018;4:35-6  Back to cited text no. 2
    
3.
Kathpalia SK. Early maternal feeding versus traditional delayed feeding after cesarean section: A pilot study. J Obstet Gynaecol India 2017;67:178-82.  Back to cited text no. 3
    
4.
Care after Caesarian Section. NICE pathway 2020: Subsection 1.6.4.1. Available from: https://www.nice.org.uk/guidance/cg132/chapter/1-Guidance#recovery-following-cs. [Last accessed on 2020 Aug 02].  Back to cited text no. 4
    




 

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