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Assessing the effect of sugar-free chewing gum use on the residual gastric volume of patients fasting for gastroscopy: A randomised controlled trial

Best, GWJ, Fanning, SB, Robertson, IK, Blackford, D and Mitchell, BL 2019 , 'Assessing the effect of sugar-free chewing gum use on the residual gastric volume of patients fasting for gastroscopy: A randomised controlled trial' , Anaesthesia and Intensive Care, vol. 47, no. 6 , pp. 541-547 , doi: 10.1177/0310057X19886881.

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There is no clear consensus in the current guidelines published by major international anaesthetic associations on what is the most appropriate time for a patient to stop chewing gum. This open-label balanced-group randomised controlled trial aimed to evaluate whether the chewing of sugar-free gum caused an increased volume or reduced pH of residual gastric fluid in fasting patients. For this study 212 patients undergoing elective gastroscopy were randomised into a control group who followed routine fasting instructions and an intervention group who were asked to chew gum while fasting. Residual gastric fluid was aspirated under direct vision via a gastroscope under anaesthesia. The primary outcome was the incidence of a gastric residual volume >50 ml in participants who chewed gum compared with a control group. Secondary outcomes were variability in the overall gastric volume distribution and gastric pH distribution between the two groups. Nine out of 110 (8.2%) in the chewing gum group and six out of 102 (5.9%) in the control group had a residual gastric fluid volume >50 ml: incidence rate ratio 1.39 (95% confidence intervals (CI) 0.51–3.77; P = 0.60). However, only one patient (in the control group) had a residual gastric volume >73 ml. There was no statistically significant difference in gastric volume distribution between groups, odds ratio 1.60 (95% CI 0.99–2.58; P = 0.054) or in the distribution of gastric pH measurement, odds ratio 0.90 (95% CI 0.57–1.44; P = 0.67). These results indicate that if there is an increase in the incidence of residual gastric volume >50 ml in patients who chew gum preoperatively, it is likely to be small. Moreover, the absence of any patients in our chewing gum group with a residual gastric volume >73 ml is reassuring.

Item Type: Article
Authors/Creators:Best, GWJ and Fanning, SB and Robertson, IK and Blackford, D and Mitchell, BL
Keywords: chewing gum, fasting guidelines, gastroscopic suctioning, pulmonary aspiration, residual gastric volume
Journal or Publication Title: Anaesthesia and Intensive Care
Publisher: SAGE Publications
ISSN: 0310-057X
DOI / ID Number: 10.1177/0310057X19886881
Copyright Information:

Copyright The Author(s) 2019

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