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Prolonged pre-procedure fasting time is unnecessary when using titrated intravenous ketamine for paediatric
1Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia. greg_treston@health.qld.gov.au
Insights
Fasting before paediatric procedural sedation (PPS) does not prevent vomiting; longer fasting times may increase vomiting incidence. Age is a significant factor in post-sedation vomiting.
Area of Science:
- Emergency Medicine
- Paediatric Sedation
- Clinical Practice Guidelines
Background:
- Paediatric procedural sedation (PPS) is frequently performed in emergency departments (EDs).
- Current guidelines often mandate prolonged fasting periods for children undergoing PPS.
- Evidence supporting these fasting guidelines for reducing vomiting and aspiration pneumonitis is limited.
Purpose of the Study:
- To investigate the association between preprocedure fasting duration and vomiting in children undergoing ketamine procedural sedation in the ED.
- To evaluate the incidence of intraprocedure and postprocedure vomiting in relation to fasting times.
- To identify risk factors for vomiting in paediatric procedural sedation.
Main Methods:
- Prospective data collection from 272 children aged 1-12 years undergoing ketamine procedural sedation at a single ED.
- Review of sedation data forms to record fasting times and vomiting episodes.
- Statistical analysis to determine the relationship between fasting duration, age, and vomiting.
Main Results:
- No intraprocedure vomiting was observed.
- The overall postprocedure vomiting rate was 13.9%.
- No significant association was found between shorter fasting times and reduced vomiting; a trend towards increased vomiting with longer fasting times was noted (P=0.08).
- Vomiting incidence increased with patient age (P=0.0007).
- No cases of clinically evident aspiration pneumonitis occurred.
Conclusions:
- Prolonged preprocedure fasting does not decrease postprocedure vomiting in paediatric procedural sedation.
- Longer fasting durations may be associated with an increased incidence of vomiting.
- Increasing patient age is a significant risk factor for postprocedure vomiting.
Background:
Paediatric procedural sedation (PPS) is a common procedure in most general EDs. Many departmental guidelines suggest mandatory fasting times for children undergoing PPS, in an attempt to decrease the incidence of postoperative vomiting and (theoretically) aspiration pneumonitis, despite there being little or no evidence in the literature to support these mandatory fasting times.
Objectives:
To prospectively address the relationship between preprocedure fasting time and intraprocedure or postprocedure vomiting in children aged 1-12 years undergoing procedural sedation with intravenous ketamine in the ED.
Methods:
From January 1999 to May 2000 all children presenting to the Royal Darwin Hospital Emergency Department with a condition requiring ketamine PPS were enrolled for data collection after parental consent was obtained. Titrated intravenous ketamine was administered via protocol. Prospective ED procedural sedation data collection forms of 272 consecutive cases of titrated intravenous ketamine sedation were reviewed.
Results:
Fasting time was accurately recorded on 257 (95%) data collection forms. There was no intraprocedure vomiting. Overall rate of postprocedure vomiting was 13.9%. No statistically significant association between decreased fasting time and increased incidence of vomiting was found. In fact, there was a trend towards increased incidence of vomiting with increased fasting time (P = 0.08). The rate of vomiting of those children fasted 3 h or greater preprocedure (20/127 or 15.8%) was over twice the rate of those fasted less than 1 hour (2/30 or 6.6%). Incidence of vomiting was significantly associated with increasing age (P = 0.0007). No clinically evident aspiration pneumonitis occurred.
Conclusion:
Prolonged preprocedure fasting time did not reduce the incidence of postprocedure vomiting in this case series; to the contrary there was a increased incidence of vomiting with longer fasting times (P = 0.08). There was an increase in postprocedure vomiting with increasing age of the patients.
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