On Wednesday 07 August 2002 17:17 pm, Jeanne Brotherton wrote:
>
> As to the "clean" bowel, we all know that the gastric system isn't
> exactly clean to begin with, but the family may need to talk this over
> with the surgeon to see what is thinking.  As we know and studies
> support, the gastric emptying time for human milk is pretty short and
> absorption is fairly complete.

I can add some insight from the perspective of a med/surg nurse.  For
most operations, the purpose of having someone NPO for several hours
before surgery is to make sure the upper gastrointestinal tract is
relatively empty to prevent vomiting and aspiration of stomach contents
while under anesthesia.  The newest findings are indeed that for most
patients that it is appropriate to continue clear liquids up to 3-4
hours prior to surgery.  Patients who are deemed at higher risk of
aspiration due to underlying physical conditions are still kept NPO from
midnight.

For patients who are undergoing colon surgery, the care is a little
different.  The goal is to get the entire digestive tract as empty and
as clean as possible.  These patients are generally on nothing but clear
liquids for a couple of days prior to surgery.  In addition, they are
given a fairly aggressive bowel cleansing prep.  This may include
anything including magnesium citrate (a carbonated electrolyte solution
that promotes bowel emptying), Fleets phosphosoda (a similar prep but
not carbonated), the osmotic solutions like GoLytely or NuLytely (which
is a gallon worth of stuff to drink over a few hours), large-volume
enemas, or a combination.  For example, they might get either the mag
citrate or phosphosoda 2 days prior to surgery and then the GoLytely the
day before and a large volume enema the morning of surgery.  The prep
used varies institution to institution and from surgeon to surgeon.
Sometimes the patient may be given instructions and the medications to
do the prep at home; in the past and still in some cases today, patients
were hospitalized a day or two before surgery to complete the prep.
Sometimes heavy doses of oral neomycin and e-mycin are given the day
before surgery to reduce the bacterial count in the intestines.

Obviously with a very young baby you are not going to want to do that
kind of aggressive bowel prep. Therefore, for that kind of surgery, they
are going to want to have the baby on something that has no residue.
Even though breastmilk is digested very rapidly, it still has residue
that has to move through the intestines as waste.  The Pedialyte, from
what I understand, does not really have any residue.  2-3 days is
probably an appropriate time frame to make sure that the last breastmilk
ingested has had time to move all the way through the intestines.

Hope that makes the situation make a little more sense.  What an awful
position to be in.  :-(

--
Elisa H. Casey
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