No Need to Go on Empty So Long Before the Surgery

If you had elective surgery more than four years ago, chances are you were told not to eat or drink after midnight on the day of your operation. Doctors used to believe that eating or drinking too soon before surgery would cause vomiting, which could be very dangerous to an anesthetized or groggy patient.

But the American Society of Anesthesiology revised its guidelines in 1998 so that prolonged fasting is no longer necessary. Patients can have clear liquids up to two hours before elective surgery, a light breakfast (tea and toast) six hours before the procedure and a heavier meal eight hours before. Still, a study by researchers at a Dallas hospital shows that old habits die hard.

Researchers at Presbyterian Hospital interviewed 155 patients about their experiences. The majority was still being told to have nothing by mouth, liquid or solid, after midnight, regardless of when their operation was scheduled that day.

On average, patients fasted for 12 to 14 hours, which is much longer than the anesthesiologist group suggests. And some people had gone without liquids for as long as 20 hours.

With modern anesthesia, inhaling bits of food while under anesthesia is a rare complication, and prolonged fasting can cause headache, dehydration, low blood sugar and other problems, report the researchers. “You don’t have to be thirsty before surgery. And you don’t have to have a caffeine withdrawal headache,” says Jeannette T. Crenshaw, family education coordinator at Presbyterian Hospital.

Julian A. Gold, co-chairman of the department of anesthesia at Cedars-Sinai Medical Center in Los Angeles, said that he has followed the new guidelines on clear liquids for years but that the food recommendations are more complicated. “I’m concerned that people will take it to mean they can go to McDonald’s on their way to the hospital,” he says.

Gold points out that it is especially important to continue taking any medicines that control chronic diseases. People sometimes believe that “nothing by mouth” means they shouldn’t take their pill with a sip of water, he says. (American Journal of Nursing: 102 (5): 36-45)

Hearing Loss in Women Coincides With Estrogen Drop, Study Says

Estrogen is a hormonal multi-tasker in women, contributing to roles as diverse as memory storage and bone growth. Now a South Korean study confirms yet another role for the hormone: It may be involved in hearing sensitivity. Researchers found that when estrogen levels start to slide at menopause, so does hearing.

In a study of more than 1,800 women older than 49, researchers at the University of Ulsan in Seoul found that hearing loss was most common in the older women. That’s no surprise, considering that about a third of people older than 65 experience some hearing loss. But they also found that though all the post-menopausal women had low estrogen levels, 11.6% of those in the group with the least estrogen had hearing loss, compared with 2.8% of those with the most estrogen.

Though other studies have indicated that estrogen-related bone loss from key ear structures could explain hearing problems in older women, this study didn’t find that to be true. Spine and leg bone density studies were done on all the women and did not appear to be related. Other studies suggest the chemicals that transmit messages in the brain may be affected by estrogen.

A small number of women were on hormone replacement therapy, but there were not enough women in the group to enable the researchers to know if it prevented hearing loss. (Obstetrics and Gynecology 2002:99:726-730)

Birth-Control Pill Users Who Are Overweight Risk Pregnancy

Despite the fact that more than 500,000 U.S. women who take birth control pills become pregnant each year, there have been few studies exploring the biological factors that might play a role in pill failure. Take body weight, for instance. The first study in more than two decades to take a close look at weight and unintended pregnancy indicates that heavy women have a 60% higher risk of pill failure than women of lower weight. And the lower the hormone dose, the greater the risk.

Researchers interviewed more than 600 women about their contraceptive use, including the type of oral contraceptive pills they took at various times in their lives, and their weight and pregnancy histories for about 12 years on average. This information allowed the researchers to analyze the number of pregnancies that occurred among women in four categories of body weight.

Women on the pill who weighed the most--that is, more than 155 pounds--were more likely to become pregnant than women in any of the three lower categories. According to Victorial L. Holt, associate professor of epidemiology at the University of Washington in Seattle, these women may not have enough progestin or estrogen circulating in their blood to prevent conception for two reasons: Heavy women may metabolize the drug quickly, and these hormones are absorbed by fat. (Obstetrics and Gynecology:99:5: 820-826)

Cancer Treatment May Dull the Sense of Taste, Researchers Find

Weight loss is a cause for celebration for many healthy people, but for a cancer patient too much weight loss can mean an emaciated appearance and weakened immunity. This problem stems, in part, from changes in taste and odor perception. Recently researchers at Duke University demonstrated for the first time how much sensitivity is altered. Now they are experimenting with natural flavor enhancers to see if boosting the taste and smell of foods will lead to weight gain.

Thirty-three elderly people with lung cancer were studied one month after they started chemotherapy. Along with asking them about the changes they sensed, Susan Schiffman, professor of medical psychology at Duke, and her colleagues tested the patients’ ability to recognize the tastes of salt and sugar, and the smell of menthol (a minty scent) and phenyl ethyl alcohol (rose scent). They found that 39% of the patients needed larger than normal amounts of salt to recognize its taste, and 58% needed larger amounts of sugar to recognize sweetness. Their ability to detect and recognize odors was also impaired.

Although the researchers have not yet determined the relationship between these dulled sensations and mortality, they did find that the more salt a person needed to recognize the taste, the lower his body mass. And the more taste and odor perception problems a person had, the more likely he was to have appetite and weight problems.

The Sad Bottom Line: There Is No Easy Way to Get Fit

Many fitness experts have been saying that electrical stimulation devices don’t strengthen and tone muscles while you work at your computer or read a book. Now there’s scientific evidence to support their statements. Researchers at the University of Wisconsin-La Crosse were unable to document claims that the machines can give you rock-hard abs or firmer thighs.

Researchers compared people who used electrical muscle stimulating--or EMS--devices three times a week for 45 minutes to those who used a fake treatment. After eight weeks, the 16 college students whose upper arm, thigh and abdominal muscles were treated with an EMS device had no change in skin fold measures, muscle girths or strength.

Eleven students in the group with the ineffective treatment did just as poorly, though the researchers acknowledged that the men and women could probably tell that they weren’t getting a real treatment.

Also telling was the fact that most of the volunteers said they would rather go to the gym and lift weights for the average 45-minute session.

The U.S. Food and Drug Administration does require that EMS devices meet federal safety standards. The agency has not approved such devices for weight loss. (The Journal of Strength and Conditioning Research: 16 [2]; 165-172)

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Dianne Partie Lange can be reached by e-mail at DianneLange@cs.com.