AB088. SOH23ABS_143. Sips til section : The National Maternity Hospital Experience

Background: The unpredictability of an obstetric operating list has the impact of inadvertent longer fasting times for patients. Prolonged fasting not only contributes to anxiety in the perioperative period, but perioperative dehydration also causes hemodynamic instability during anaesthesia and increased incidence of postoperative nausea and vomiting.

Methods: We audited fasting times for women scheduled for elective caesarean section (n=30) at our institution. Re-audit of the perioperative fasting times after the implementation of the policy was also done. Policy development included clear discussions about the change in clear fluid restriction with due considerations to safety and risk assessment preoperatively and agreement on adherence to the conventional solid fasting guidelines and proton pump inhibitors (PPIs) administration protocol as per enhanced recovery after surgery (ERAS). Implementation of the new policy involved educational staff meetings, teaching sessions, updating the patient information packs, and use of posters and “sips till section cards” as means to ensure compliance and to monitor the safe and responsible implementation of the policy.

Results: The mean clear fluid fasting time was 11.5 hours (n=30) before the implementation of the policy. The mean fasting time decreased to 1 hour 14 minutes (n=30) after the implementation of the policy.

Conclusions: Our “sips till section policy” not only ameliorates the evidenced negative effects of prolonged fasting but is more tailored towards the patient cohort who are fundamentally candidates for neuraxial anaesthesia as the primary mode of anaesthesia. Surveillance in liaison with the clinical risk department to identify adverse events such as pulmonary aspiration is in place. To date, there have been 100 patients benefiting from our sips till section initiative, with no adverse events noted.

Keywords: Caesarean; dehydration; fasting; perioperative; sips