Challenging the “No Food After Midnight Before Surgery” Rule | Lifestyles


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BY LINE: By Keith Roach, MD

DEAR DR. ROACH: Why is it that no matter what time a surgery is scheduled, the rule is “no food or drink after midnight”? My recent intervention was scheduled for 12:30 p.m. I was told I couldn’t eat after midnight. My procedure would take two hours and the recovery took two hours. It’s more than 16 hours without eating! When I told the planner that I would have a sick headache from not having food for 16 hours, I was told that was the policy. Period. No food after midnight. “Besides,” she said, “they will give you food while you are recovering.”

Well, I’m sorry, but a bathroom cup-sized glass of juice and crackers has no effect. It is too late then. And as it happened, they didn’t give me anything in recovery anyway. I ate on the way home, but was sick for hours. If my operation had been scheduled for 6 am it would have been 10 am without food. At noon, 4 p.m. without food. Etc. Why the one-size-fits-all policy? The feeding cut-off time should be adapted to the time of surgery. Maybe midnight is just an easy time to remember. – Mo

ANSWER: I agree with you that 16 hours without food is both cruel and unnecessary and can actually lead to harm, such as worsening postoperative nausea and vomiting. Even 10 hours is more than necessary. The American Society of Anesthesiologists, like most expert societies, recommends that adults refrain from eating heavy food (including fat and meat) eight hours before surgery; fast on any solid food or milk six hours before surgery; and fasting of clear fluids two hours before surgery.

In your case, with a procedure scheduled for 12:30 pm, you could certainly have woken up early (say 6:00 am) and had a light breakfast; then had water, black coffee or tea until 10:30 am. I can’t say why your surgical center was so dogmatic.

Of course, some people can have medical conditions that require longer periods of fasting, so you should ask your surgeon or anesthesiologist what and when to eat.

DEAR DR. ROACH: My recent echocardiogram indicated that I had 50% heart function, which my doctor said was “weakly normal”. I’m a 74 year old male who exercises two to three times a week on a treadmill, spending 45 minutes at 3.5 mph covering 2.6 miles. Can exercise increase heart function, or once it’s gone, it’s gone? – MC

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

What is more important than any heart measurement is what you are able to do. You train pretty well. It is likely that if you increase your speed, you will gradually get used to a higher speed as your heart function improves. Exercise can improve heart function in almost anyone.

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Dr Roach regrets not being able to respond to individual letters, but will fit them into the column whenever possible. Readers can send questions by email to [email protected] or by mail to 628 Virginia Dr., Orlando, FL 32803.

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