Fozia Ali1*
Pre- operative, thirst is common and may cause intense patient discomfort. It is a powerful symptom that surpasses all other sensations. The etiology of per-operative thirst is complex and has not been yet completely exposed. Among various pathophysiologic factors, preoperative fasting and intraoperative fluid loss may lead to hyperosmolarity and hypovolemia. Moreover, certain drugs utilized in anesthetic practice (e.g., glycopyrrolate and other anticholinergic agents used for reducing salivary secretion) may promote a thirst sensation, which may be further intensified by prolonged surgical and intubation times. Pre-procedure fasting is used to reduce the risk of vomiting and aspiration pneumonia during sedation and general anesthesia. However, prolonged fluid restriction causes thirst symptoms to develop (e.g., dry mouth, swollen tongue), which can lead to great discomfort. Several factors contribute of patients’ thirst. In the preoperative period, absolute fasting for prolonged periods (eg, more than six hours) and preoperative anxiety and fear trigger hormonal reactions that result in decreased saliva production, which dries the oral cavity. In the intraoperative period, medications, orotracheal intubation, and bleeding can cause dehydration Current guidelines related to pre-procedure fasting for elective procedures to recommend a minimum fasting period of 2 hours Nil-Per-Oral (NPO) for clear fluids. Despite these recommendations, current practice is for patients undergoing surgical and other medical procedures that require sedation or anesthesia to receive standardized “nil-by-mouth” fasting instructions at a pre-specified time interval before procedures. For example, “no eating or drinking after midnight” is the most common. It is not common for fasting instructions to be updated even when there are significant delays in procedure start time As a result, fasting durations far exceed the recommended requirement for most patients undergoing medical and surgical procedures. Prolonged fasting for many hours prior to surgery could lead to unstable hemodynamics, might be potentially harmful and influence cardiac preload as well as it has a significant effect on patient recovery.
Objectives:
To identify the intensity and discomfort caused by thirst in pre-operative patients. To assess the management of patients’ thirst in preoperative phase. To assess the satisfaction level of patients after intervention.Materials and Methods: Cross Sectional Study was used at Operating Room at SKMCH & RC in two months. 147 patients were participated through the convenience techniques.
Results:147 (100%) patients participated in study after informed consent, 53% of breast, 43% of urology and 1% of orthopaedics patients participated. 79% were day cases and 21% were admitted patients. 16% of patients reported very thirsty, 76% were reported thirsty and 6% were neutral. 83% of patients’ responded very uncomfortable and 17 % were a little uncomfortable due to thirst. There is a positive relationship intensity with thirst discomfort. 67% of patients received intervention and 33% refused to take intervention. 83% were satisfied after intervention 17% were very satisfied.
Conclusion: The incidence of thirst intensity and discomfort is high in patients during the per-operative period. Thirst needs to be evaluated by the healthcare team that works in the per-operative area, for it to be appropriately treated. However, care improves by proper and timely assessment and management of thirst in surgical patients.