How Long Should Patients Refrain from Oral Food and Fluid Intake after General Anaesthesia? An Assessment of the Swallowing Reflex of Postoperative Neurosurgical Patients

Abstract

Objective: Our aim was to detect swallowing abnormalities in patients after short-term neurosurgical interventions under general anaesthesia, comparing patients with supratentorial operations with a group undergoing extracranial neurosurgery (nucleotomy).

Methods: 20 patients in each group were examined by fiberoptic endoscopic evaluation of swallowing (FEES) after general anaesthesia.

Results: No patient demonstrated dysphagia, aspiration, or oxygen desaturation.

Conclusion: In these patient groups, early postoperative feeding was safe. Postoperative food intake can probably be allowed early after general anaesthesia.

Key words

Deglutition - intubation - dysphagia

References

• 1 Aldrete J A. The post-anesthesia recovery score revisited.  J Clin Anesth. 1995;  7 89-91
• 2 Rimaniol J M, D'Honneur G, Duvaldestin P. Recovery of the swallowing reflex after propofol anaesthesia.  Anesth Analg. 1994;  79 856-859
• 3 D'Honneur G, Rimaniol J M, el Sayed A, Lambert Y, Duvaldestin P. Midazolam/propofol but not propofol alone reversibly depress the swallowing reflex.  Acta Anaesthesiol Scand. 1994;  38 244-247
• 4 Murphy P J, Langton J A, Barker P, Smith G. Effect of oral diazepam on the sensitivity of upper airway reflexes.  Br J Anaesth. 1993;  70 131-134
• 5 Murphy P J, Erskine R, Langton J A. The effect of intravenously administered diazepam, midazolam and flumazenil on the sensitivity of upper airway reflexes.  Anaesthesia. 1994;  49 105-110
• 6 Burgess G E, Cooper J R, Marino R J. Laryngeal competence after tracheal extubation.  Anesthesiology. 1979;  51 73-77
• 7 Hamdy S, Aziz Q, Rothwell J C, Crone R, Hughes D, Tallis R C, Thompson D G. Explaining oropharyngeal dysphagia after unilateral hemispheric stroke.  Lancet. 1997;  350 686-692
• 8 Leder S B, Cohn S M, Moller B A. Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients.  Dysphagia. 1998;  13 208-212
• 9 Ajemian M S, Nirmul G B, Anderson M T, Zirlen D M, Kwasnik E M. Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation: implications for management.  Arch Surg. 2001;  136 434-437
• 10 DeVita M A, Spierer-Rundback L. Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes.  Crit Care Med. 1990;  18 1328-1330
• 11 DeLarminat V, Mantravers P, Dureuil B, Desmonts J M. Alteration in swallowing reflex after extubation in intensive care unit patients.  Crit Care Med. 1995;  23 486-490
• 12 Bishop M J, Hibbard A J, Fink B R. Laryngeal injury in a dog model of prolonged endotracheal intubation.  Anesthesiology. 1985;  62 770-773
• 13 Bishop M J. Mechanisms of laryngeal injury following prolonged tracheal intubation.  Chest. 1989;  96 185-186
• 14 Bastian R W. Videoendoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow.  Otolaryngol Head Neck Surg. 1991;  104 339-350
• 15 Langmore S E, Schatz M A, Olsen N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration.  Ann Otol Rhinol Laryngol. 1991;  100 678-681
• 16 Kearney R, Mack C, Entwistle L. Withholding oral fluids from children undergoing day surgery reduces vomiting.  Paediatr Anaesth. 1998;  8 331-336
• 17 Jin F, Norris A, Chung F, Ganeshram T. Should adult patients drink fluids before discharge from ambulatory surgery?.  Anesth Analg. 1998;  87 306-311
• 18 Leder S B, Sasaki C T, Burrell M I. Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration.  Dysphagia. 1998;  13 19-21
• 19 Barquist E, Brown M, Cohn S, Lundy D, Jackowski J. Postextubation fiberoptic endoscopic evaluation of swallowing after prolonged endotracheal intubation: a randomized, prospective trial.  Crit Care Med. 2001;  29 1710-1713
• 20 Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Data Base Syst.  Rev. 2003;  (4) CD 004 423
• 21 Brehmer D, Laubert A. Diagnosis of postoperative dysphagia and aspiration. Fiberoptic-endoscopic controlled methylene blue drinking.  HNO. 1999;  47 479-484