Perioperative thirst management

Thirst is one of the most prevalent and distressing symptoms experienced by patients within 24 hours of surgery; however, it remains under-recognised, under-measured and under-treated in clinical practice. This narrative article explores the physiology, aetiology, assessment and management of perioperative thirst, illustrated through a clinical case example. Thirst perception is regulated by complex neural and hormonal mechanisms involving higher-order brain centres, responding to changes in plasma osmolality, sodium concentration and blood volume. In the perioperative period, thirst may arise from true fluid and electrolyte imbalances caused by prolonged fasting, bowel preparation, intraoperative losses, or postoperative nausea and vomiting. Alternatively, it may manifest as xerostomia (dry mouth) due to anxiety and medications, occurring independently of true dehydration. Assessment should evaluate both thirst intensity using validated scales and the resulting patient discomfort. Management strategies include methods addressing underlying fluid and electrolyte disturbances, and providing immediate symptom relief. This article aims to enhance healthcare professionals’ understanding of thirst physiology, encourage active symptom assessment, and promote evidence-based interventions, including shortened preoperative fasting protocols and therapeutic use of cold oral therapies. Recognising and addressing perioperative thirst represents an important, yet often overlooked, aspect of patient-centred care that can significantly improve postoperative comfort and patient experience.