Do not eat or drink after midnight before surgery

In My Humble Opinion
1

I go in tomorrow for shoulder surgery. And those are my instructions, which I will follow.

Being curious I did Google why I need to do that. So do know the answer of why. You could die choking on your stomach contents under anesthesia.

OTOH, I saw numerous counter arguments from reputable sources, such as hospitals and surgery centers who do not require the “nothing after midnight” thing. And claims that it was based on an old study, and up to date anesthesia doctors don’t require it anymore.

So is my anesthesiologist not up to date?

Not looking for medical advice. I’ll do as the doctor ordered.

My question/comment is, you ever get the feeling your doctor is just doing the same stuff they learned in medical school 30 years ago?

2

I would guess it has something to do with the time of surgery, too. May be a difference if we’re talking a 8 AM surgery vs a 1 PM surgery.

3

“Nothing after midnight” is much stricter than current guidelines, but also very easy for patients to follow.

Here are the current American Society of Anesthesiologists guidelines, which are an update to the full 2017 guidelines.

The short answer is that “absolutely no food or drink before midnight” is no longer their guidance.

4

If they’re old enough, they’ve seen medical advice go from X to Y and then, say ten years later, go from Y back to X. So they may decide to wait and see if the change sticks.

Because I’ve had knee surgery, my dentist has me take antibiotics before teeth cleaning. I hear that’s no longer required, but he’s not willing to take the chance.

5

The idea is to reduce the risk of getting food in the lungs. Typically, many anesthesiologists prefer patients have had no solid food for eight hours, with less time for liquids. But local practices vary a little, and I am sure any anesthesiologist understands these basic things.

6

Big Anesthetics is trying to cover up that they extract their drugs from mogwai glands.

7

Last year I was having endoscopies every six weeks or so. One of them was scheduled for 2 PM, and I was told no food after midnight. I get headaches when I don’t eat, so by the time I got to the hospital I was praying for the anesthetic to kick in and end the pain, When they went to schedule my next one they tried to do it in the afternoon again, and I put my foot down, insisting on a morning appointment.

8

Sometimes they definitely do, even when it makes no sense. I have an example from when I had a retina tear but the details are lengthy and complicated. Suffice it to say the doc instructed me to do something that he told all his patients to do, but in my particular case was incorrect. I’m happy to share the details but the bottom line is he was wrong and I was right. I did what I decided and disregarded the doc’s instructions, and my retina tear healed perfectly.

I don’t recommend doing what I did unless one is absolutely certain it is the correct thing to do.

Good luck with your shoulder surgery tomorrow

9

Yeah, but most places still say “nothing after midnight” even if your surgery is in the mid afternoon. Mainly because that’s an easy rule to follow.

If they say “nothing for 8 hours before surgery”, people WILL screw that up.

When I had my gallbladder yanked, I declined the first surgery slot they offered me - at 1 PM - because I KNEW there would be emergencies and delays. MY husband had sinus surgery scheduled for 2 PM - they didn’t take him back until 4 PM.

“same stuff as 30 years ago” in some cases could be changed, but an abundance of caution would tend toward an attitude of “well, it DOES work well, and there aren’t studies PROVING it’s OK to have a taco in pre-op, and I don’t like getting sued, so…”.

Before one procedure (my wrist surgery, I think), they asked “and have you eaten anything since midnight”. I said “No… oh, except that cheeseburger I had on the way”. I quickly added “Just kidding. Any cheeseburger I could have bought this time of day would NOT be worth risking my life for”.

Exactly.

When I had an emergency C-section, I was already in the hospital (pre-eclampsia but they thought I was stable). Some last-minute bloodwork changed that from “going home today” to “having the baby as soon as everyone can arrive”, and she was breech, so c-section it was. I’d eaten much more recently than the 8 hours or whatever they’d have preferred, but it was urgent - and I made sure they knew how recently I’d eaten so they could be prepared to take action if needed.

Before the gallbladder surgery, I was allowed water until 2 hours or thereabouts before. I took full advantage - as being dehydrated makes IV placement ever so much tougher.

Since I’ve been on Ozempic, I’ve learned that they need you to be off it for a full week before anything elective - even the full 8 hours is simply not enough time (and I’ve had personal evidence of that).

10

Speaking as an older doc, bluntly, yeah it’s a risk. The advantage of a long career is experience and judgement. The disadvantage is that change is hard. It takes conscious effort to implement new guidelines and the longer those habits have been in place the more the effort has to be. It is also harder yet to lead the way if our local specialists are slow to embrace newer guidelines. And often they are slow to change up what has worked well for them to date. Or are not yet convinced they should.

11

When I got my port the surgery was scheduled for 4 PM. I had permission to take a prescription med with a very very small sip of water.

When they were asking me about food and drink I was all “YES TO TAKE MY PRESCRIPTION. IT WAS A TINY SIP YOU SAID IT WAS OKAY”.

They were all “it was; you can calm down”.

12

Yeah, the last time i had a procedure they asked me not to eat that day, but said it was okay to drink clear liquids until 2 hours prior. They also told me to go ahead and take my morning pills, as early as possible. I took them with lots of water, and then had a cup of tea, as the procedure wasn’t scheduled until 10am.

I’m pretty comfortable fasting, so i didn’t have any calories that morning. But they would have been okay with my dissolving sugar in my morning tea.

And the two hours was completely adequate. My stomach was empty. I had an upper endoscopy, and the doctor had wanted to sample the pH of my gastric contents, but there wasn’t enough there for him to get a good sample.

13

Yup. I’ve ‘been under the knife’ at least half a dozen times without any problems, except for the last time, 2 years ago.
I came out from under with a raging headache, Nauseated, and with immediate diarrhea.
Fortunately, they had anti-nausea drugs, barf bags, and a bedpan at the ready, so obviously it wasn’t that unusual.
The OR nurse who had to clean me up wasn’t happy. But my feeling was that they shoulda given me better drugs.
I hope to get a chance to speak to the anesthesiologist when I go in again in a couple of weeks. I want whatever they used to give me.

14

Re the OR nurse: Sorry, lady, shit sometimes literally happens, and you did not go into this job for the glamor of it.

After my 2023 colonoscopy, they told me as soon as I woke up that I’d had an explosion while I was under sedation, which was why I came to wearing a different gown. Next time around, I refused that prep and went back to my old “favorite”.

You can get your records and find out what all you were given. You’ll have a chance to speak with an anesthesiologist beforehand, and if protocol A worked, and protocol B caused problems, you can discuss options. That’s what I did this last time also. The prep was fine, no blowouts, but when I came to my mouth felt like the Sahara was a rainforest by comparison.

Turns out, they had given me something (glycopyrrolate) to dry up secretions in my mouth. I was (mentally) on the war path about that - I mean, some doctors will do x, y, and z just because, and if this anesthesiologist administered all that because he was used to doing it, I wanted to know. Especially since the dryness lasted for quite a few hours, and eating anything posed a genuine choking risk.

So I called - and actually spoke with him, and he explained that I had indeed started producing large amounts of saliva. During or maybe just before the upper GI. So, aspiration was a real concern, and it was appropriate.

But, he was surprised that the dry mouth lasted as long as it did. So next time around, I’ll talk with the anesthesiologist beforehand, mention that problem, and suggest that if possible, they try a lower dose at first - then go up to the full dose if needed. Because a) they’re supposed to keep me alive, b) that’s my goal as well, and c) I’m all about reducing unnecessary misery, but if I absolutely have to, I’ll deal with it.