Introduction: This preoperative fasting audit is a detailed examination of the actual practice of patient oral intake prior to surgical procedures at our tertiary care center. It aimed to assess the fasting guidelines provided to patients, ensuring their safety and well-being during the surgical process. Methods: This audit was conducted for a period of one month in October 2023 and it included 109 patients who underwent elective surgery of all ages and either gender. During this audit, we have meticulously analyzed the duration of fasting that the patients underwent before each type of surgery. This included a detailed record of the time intervals between the last meal or drink and the scheduled operation, with regards to the nature of food or drink that patients were allowed or denied from consuming prior to the procedure. Results: Majority of the patients in this study underwent orthopedic procedures (57/109, 52.3%). The average duration of fasting was 9.66 h. Only 26.4% of patients were fasting for the recommended 8-hr period. 45.8% were noted to be fasting between 9-10 hr. Overall, a total of 72.4% of patients exceeded the recommended 6-8 hr preoperative fasting. 18 (16.5%) patients fasted between 12-16 h. An interesting finding of this audit was that only pediatric patients were drinking clear fluids up to allowable 2-hr preoperatively. Conclusion: Despite evolving guidelines advocating for shorter fasting periods, our study alongside similar studies revealed persistent challenges in translating these guidelines into routine practice.

Background: The study aims to compare the effectiveness of Remifentanil, Nitroglycerin, and Esmolol on blood pressure and heart rate during rhinoplasty surgery. The research design used is a cross-sectional study with probability randomized sampling. Demographic data, including age, gender, marital status, and weight, are collected for analysis. Methods: A total of 45 participants from Al Shifa Hospital are divided into three intervention groups: Remifentanil, Nitroglycerin, and Esmolol. systematic random sample assignment is done for each participant. The normal doses of the medications vary based on patient characteristics and the extent of the procedure. Data is collected from patient records of drug downloads in the surgical department. Results: The study involved 45 participants, with the majority falling into the 29-39 age group. Most participants were female and classified as overweight. The analysis of demographic data revealed variations in heart rate and blood pressure among diverse groups, such as underweight participants having the highest mean heart rate and married participants that have the highest mean systolic and diastolic blood pressure. Discussion: The analyses imply superior hemodynamic regulation, enhanced visibility of the surgical field, attenuated intraoperative hemorrhaging, and improved postoperative sequelae with remifentanil compared to nitroglycerin and esmolol. However, consideration of discrete patient attributes and demographics is critical when determining the optimal pharmaceutical agent and dosage. The research methodology adhered to ethical principles and obtained appropriate informed permission from all subjects. Conclusions: The data suggest enhanced control of blood pressure, heart rate, and other cardiovascular measures with remifentanil versus nitroglycerin and esmolol. Improved visibility of the surgical field and reduced bleeding during surgery were also observed. Patients may have had superior outcomes after surgery as well. However, more statistical analysis is needed to determine if demographics were related to cardiovascular changes. Limitations include small sample sizes at one center without long-term assessments. Moving forward, studies utilizing larger, multi-center samples in controlled trials are necessary to make more definitive conclusions about the effectiveness of these medications in rhinoplasty.