Sir,
We thank Dr Wagh et al.[1] for their comments on the guidelines “Perioperative fasting and feeding in adults, obstetric, paediatric, and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists.” Our publication was based on evidence gathered from mainly four databases: Pubmed, Cochrane library, EMBASE, and Google Scholar. For formulating the guidelines, evidence of the highest quality (meta-analysis, randomised controlled trials (RCTs), observational trials) was classified as per the Grading of Recommendations Assessment, Development and Evaluation protocol. The research question on postoperative feeding yielded RCTs, and a meta-analysis was performed. Most of the studies published were comparative trials between early feeding group (6–8 h) and late feeding group (12–24 h). We found that return to bowel function and passage of flatus was earlier in the early feeding group. The incidence of ileus was the same in both the groups. Based on this meta-analysis, the recommendation was framed.[2]
Kathpalia et al. in their study considered early feeding as 6 h postoperatively. They do recommend early feeding. However, there were serious limitations to their study. The sample size calculated was not met. Hence, it was not included in the meta-analysis.[3] We read with interest the publication titled “Are we starving our caesarean patients too much postoperatively?” by Sathe et al. The authors in their case study have administered oral liquids 2 h postoperatively and have not found any incidence of nausea or vomiting or other complications. However, the analysis of data has not been presented in the publication. On critically appraising the article, there seems to be a lack of evidence.[4]
Studies that talk about the enhanced recovery after surgery protocol do talk about early discharge and shorter duration of hospitalisation. Hopefully, early resumption of oral feed will be considered as an important milestone and more studies will be performed in this direction.
We agree with the authors that the ultrasound may be a useful tool for follow-up and advising liquids, but we could not find any published studies in the databases mentioned above.
Author contributions
All authors have read and have approved the manuscript for submission.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Perioperative Fasting Guidelines-No oral intake up to 8 hours after caeserean section? Indian J Anaesth. 2020;64:922–3. doi: 10.4103/ija.IJA_878_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
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