Chewing Gum Before Anesthesia or Surgery
In the last few years, whether patients can use chewing gum leading up to their procedure has become a topic of interest within the anesthesia and surgical communities.1 While the initial and historic preoperative tradition has been to keep patients nil per os (“nothing by mouth”) prior to anesthesia to reduce the risk of aspiration,2 chewing gum has remained a questionable exception.
Preoperative use of chewing gum has been associated with decreased preoperative anxiety.1 In a 2022 randomized controlled trial for female patients undergoing elective gynecologic surgery, the use of chewing gum during the preoperative fast, when compared to fasting without the use of chewing gum, was associated with significantly lower preoperative anxiety, using the Amsterdam preoperative anxiety and information scale (17.8 versus 20.9, respectively; P=0.009).1 The following year, a meta-analysis of randomized controlled trials investigating the potential benefits of preoperative chewing gum yielded results demonstrating that the use of preoperative chewing gum is associated with lower incidence of postoperative nausea (P = 0.0004), lower postoperative pain score (P < 0.00001), and shorter hospital course duration (P = 0.02).3 The benefit of preoperative chewing gum was further supported with a 2024 randomized controlled trial which yielded data demonstrating that chewing sugar-free gum for 15 minutes prior to surgery was associated with significantly reduced rates of requiring anti-emetic treatment (79.5% versus 95.6%; P = 0.001) in women undergoing robotic laparoscopic surgery for uterine myomas.4
While there was initial concern surrounding the safety of chewing gum use before anesthesia due to the traditional nil per os doctrine,2 this fear has been largely attenuated in recent studies, many of which support the safety and benefits of this practice.1,3,4 In the 2022 randomized controlled trial for female patients undergoing elective gynecologic surgery, the use of chewing gum was not found to produce a significant change in gastric pH (1.45 vs 1.34, respectively; P = 0.095) or estimated gastric fluid volume (0.24 ml/kg vs 0.14 mg/kg, respectively; P = 0.070) compared to the control group.1 Similar findings were demonstrated in the previously mentioned 2023 meta-analysis which also demonstrated no significant difference in gastric pH (P = 0.13) or gastric fluid volume (P = 0.25) between chewing gum and control groups.3 In the above 2024 randomized controlled trial, there were no cases of gastric regurgitation noted in either chewing gum or control groups.4
In 2023, the American Society of Anesthesiologists (ASA) released updated Practice Guidelines for Preoperative Fasting. In these guidelines, the ASA does not address whether to actively promote the routine use of preoperative chewing gum. However, they do note that patients who are found to be chewing gum during their preoperative fast should not have their surgeries delayed due to gum chewing.5
In summary, the use of chewing gum during the fasting period before anesthesia and surgery has been shown in multiple studies to have benefits, including a reduction in postoperative nausea, shorter hospitalization, and lower preoperative anxiety scores. These studies also did not find an increased risk of aspiration of gastric contents associated with chewing gum. The ASA does not currently recommend its routine use in the preoperative fasting period, but they do note that surgery should not be delayed or postponed due to its use.
References
1. Bang YJ, Lee JH, Kim CS, Lee YY, Min JJ. Anxiolytic effects of chewing gum during preoperative fasting and patient-centered outcome in female patients undergoing elective gynecologic surgery: randomized controlled study. Sci Rep. 2022;12(1):4165. doi:10.1038/s41598-022-07942-6
2. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration*. Anesthesiology. 2017;126(3):376-393. doi:10.1097/ALN.0000000000001452
3. Chen X, Chang C, Yuan X, Yang J, Li K. Efficacy and safety of preoperative chewing gum for undergoing elective surgery: A meta‐analysis of randomised controlled trials. J Clin Nurs. 2023;32(15-16):4295-4310. doi:10.1111/jocn.16604
4. Chae MS, Koh HJ. Effect of Preoperative Gum Chewing on Postoperative Nausea and Vomiting in Women Undergoing Robotic Laparoscopic Surgery for Uterine Myomas: A Randomized Controlled Trial. Life Basel Switz. 2024;14(12):1693. doi:10.3390/life14121693
5. Joshi GP, Abdelmalak BB, Weigel WA, et al. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration—A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting *. Anesthesiology. 2023;138(2):132-151. doi:10.1097/ALN.0000000000004381