Challenging preoperative guidelines: Qualitative research and implementation studies to optimize preoperative care

Abstract

Currently, guidelines are the basis for many of our daily medical decisions. However implementation of guidelines is difficult. In this thesis recommendations and the subsequent implementation of four different guidelines were examined in the field of preoperative medicine. This resulted in some controversial conclusions. In one part of the thesis, researchers investigated the guideline of preoperative fasting for adults. Patients are fasted before a procedure under anaesthesia, to prevent aspiration. It is worldwide the most important recommendation that anaesthesiologists give to their patients. Some years ago pediatric fasting guidelines relaxed their recommendations and currently allow clear fluids until one hour before anaesthesia. This resulted in a scientific debate if adult fasting guidelines could be relaxed as well. However, no major studies appeared that changed guidelines. In this thesis two studies are described that showed that a liberal clear fluid intake resulted in decreased fasting duration, improved patient well-being with comparable safety. In another part of the thesis two studies were described that evaluated patient information provisioning and informed consent from a patient perspective. These studies showed that patients value information about anaesthesia, because they want to know what will happen to them during anaesthesia. However a separate informed consent for anaesthesia had no additive value on top of the surgical informed consent for most patients. This has led to some controversial recommendations with regard to information provisioning and informed consent for anesthesia that would improve care from a patient perspective. For low-risk patients digital information provisioning with a digital informed consent could be possible. For high-risk patients surgical and anaesthetic information provisioning and informed consent should be combined.