Challenging the 'no food after midnight before surgery' rule
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 procedure was scheduled for 12:30 p.m. I was told I could have no food after midnight. My procedure would take two hours and recovery was for two hours. That's over 16 hours without eating! When I told the scheduler that I would have a sick headache due to no food for 16 hours, I was told that was the policy. Period. No food after midnight. "Besides," she said, "they will give you something to eat in recovery."
Well, I'm sorry, but a bathroom cup sized drink of juice and some crackers has no effect. It's too late by that time. And as it happened, they gave me nothing in recovery anyway. I ate when I got home, but I was sick for hours. If my surgery had been scheduled for 6 a.m., it would have been 10 hours without food. At noon, 16 hours without food. And so on. Why the one-size-fits-all policy? The food cutoff time should be tailored to the surgery time. Maybe midnight is just an easy time to remember. -- M.B.
ANSWER: I agree with you that 16 hours without food is both cruel and unnecessary, and may actually lead to harms, such as worsened postoperative nausea and vomiting. Even 10 hours is longer than necessary. The American Society of Anesthesiologists, like most expert societies, recommends for adults no heavy food (including fats and meat) eight hours prior to surgery; fasting from any solid food or milk six hours prior to surgery; and fasting from clear liquids two hours before surgery.
In your case, with a procedure scheduled at 12:30, you should certainly have been able to wake up early (say, at 6 a.m.) and have a light breakfast; then been allowed water, black coffee or tea until 10:30 am. I can't say why your surgical center was so dogmatic.
Of course, some individuals may have medical conditions that necessitate longer periods of fasting, so you should ask your surgeon or anesthesiologist what you can eat, when.
DEAR DR. ROACH: My recent echocardiogram indicated that I had 50% heart function, which my doctor said was "low 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? -- M.C.
ANSWER: Ejection fraction is a single measurement of heart function made by echocardiogram. It measures the amount of blood ejected by the left ventricle every cardiac cycle. The normal range is 50% to 75%, but 75% isn't 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 how much you are able to do. You are exercising pretty well. It is likely that if you increased your speed, you would gradually get accustomed to the higher speed as your heart function improved. Exercise can improve heart function in nearly everybody.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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