Can I Chew Gum Before Surgery? Preoperative Anxiety Relief

The question of whether chewing gum before surgery is safe often arises, especially as patients seek ways to alleviate preoperative anxiety. Understanding the implications of gum chewing involves examining its effects on bodily functions and emotional states.

Salivary Secretion And Swallowing Reflex

Chewing gum stimulates salivary secretion, which plays a significant role in oral and digestive health. Saliva, produced by the salivary glands, is essential for maintaining oral hygiene, facilitating digestion, and enabling the swallowing reflex. When gum is chewed, mechanoreceptors in the oral cavity activate salivary nuclei in the brainstem, increasing saliva production. This process aids in the initial breakdown of food and maintains the mucosal integrity of the oral cavity.

The swallowing reflex, a complex neuromuscular action, is closely tied to salivation. As saliva accumulates, it triggers the swallowing reflex, coordinating the contraction of muscles in the pharynx and esophagus. Chewing gum enhances this reflex, ensuring the oral cavity remains clear of excess saliva and potential irritants. This is particularly relevant preoperatively, where maintaining a clear airway is crucial.

Clinical studies have examined the effects of preoperative gum chewing on gastric fluid volume and pH. Research published in the British Journal of Anaesthesia suggests that while gum chewing increases salivary secretion, it does not significantly alter gastric fluid characteristics, thus not compromising surgical safety. This finding is important for anesthesiologists, as the risk of aspiration during anesthesia is a critical concern. The study indicates that gum chewing does not pose an additional risk in terms of gastric content management.

Hormonal And Neurological Factors Of Chewing

Chewing gum involves complex hormonal and neurological processes that can influence physical and psychological states. The rhythmic act of mastication initiates signals impacting brain regions associated with stress and anxiety, notably the hypothalamus, which modulates stress responses by regulating hormones like cortisol.

The influence of chewing extends beyond hormonal modulation. Neuroimaging studies show that mastication activates brain regions linked to alertness and attention, such as the prefrontal cortex, enhancing well-being and reducing stress perception. Research in Psychoneuroendocrinology highlights the anxiolytic effects of chewing gum, showing a correlation between gum chewing and decreased salivary cortisol levels in stressed individuals.

Furthermore, the neuromuscular activity associated with chewing influences the autonomic nervous system, which governs involuntary physiological functions. Studies indicate that mastication can enhance parasympathetic activity, promoting relaxation and counterbalancing the sympathetic nervous system’s fight-or-flight response. A systematic review in Neuroscience & Biobehavioral Reviews supports the notion that chewing gum can positively affect mood and stress levels through these neurological mechanisms.

Stomach Emptying And Fasting Physiology

The physiology of fasting before surgery is connected to stomach emptying and metabolic responses. Fasting is a standard preoperative instruction to reduce the risk of aspiration during anesthesia. Aspiration can lead to serious complications such as pneumonia. The stomach empties its contents through gastric emptying, regulated by neural and hormonal signals, ensuring gradual food release into the small intestine.

Gum chewing, while not involving nutrient ingestion, can influence gastric motility and secretions. The act of chewing stimulates the vagus nerve, enhancing gastrointestinal activity, potentially accelerating gastric emptying. This effect is sometimes used postoperatively to aid recovery from bowel surgery, as evidenced by a meta-analysis in the International Journal of Surgery. The analysis found that gum chewing could reduce the time to first flatus and bowel movement after abdominal surgery.

Despite these potential benefits, the preoperative context requires careful consideration of fasting protocols. The American Society of Anesthesiologists (ASA) guidelines recommend fasting from clear liquids for at least two hours and from solid foods for six to eight hours before surgery. While gum chewing does not introduce solids or liquids into the stomach, its effect on gastric secretions and motility could theoretically alter fasting physiology. However, studies show that gum chewing’s impact on gastric volume and acidity is minimal, indicating it may not significantly disrupt fasting protocols.

Anxiolysis Through Oral Sensory Stimulation

The sensory experience of chewing gum offers a unique pathway to anxiolysis, particularly relevant for individuals facing preoperative stress. Chewing provides continuous oral sensory stimulation, engaging the tactile and proprioceptive senses in a rhythmic manner. This motion has been associated with the modulation of stress-related neurotransmitters in the brain. The sensory feedback loop created by chewing can lead to a calming effect, similar to other repetitive behaviors known to reduce anxiety.

Chewing gum also serves as a distraction, diverting attention from stressors associated with impending surgery. The focus on chewing and the flavor of the gum can occupy the mind, potentially easing anxiety by reducing cognitive space for worry. This distraction engages cognitive processes that can alter stress perception. The Journal of Clinical Psychology discusses how cognitive distractions effectively mitigate anxiety, offering a non-pharmacological strategy for stress management.

Perioperative Thirst And Comfort

Thirst and discomfort are significant concerns for surgical patients due to preoperative fasting requirements. Fasting, while necessary, can lead to dehydration and a persistent sensation of thirst, exacerbating stress and discomfort. Chewing gum offers a method to alleviate these sensations by stimulating salivary glands, keeping the mouth moist and reducing the feeling of thirst. This is beneficial for patients who find the waiting period before surgery lengthy and anxiety-inducing.

Clinical trials have explored gum chewing as a means to enhance patient comfort in the perioperative setting. A study in the Journal of Perioperative Practice examined gum chewing’s effects on preoperative thirst and reported that patients who chewed gum experienced a notable reduction in thirst intensity. This suggests that the sensory and salivary stimulation provided by gum chewing can contribute to a more comfortable and less distressing preoperative experience.