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Shortened preanesthetic fasting interval in pediatric cardiac surgical patients
S C Nicolson1, A T Dorsey, M S Schreiner
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, PA 19104-4399.
Insights
Allowing clear liquids before pediatric cardiac surgery is safe. Children receiving liquids 2-3 hours prior reported greater comfort and no increased aspiration risk compared to fasting patients.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
Background:
- Recent guidelines liberalized preoperative feeding for healthy pediatric outpatients.
- The safety of this approach in pediatric cardiac surgery patients remains unclear.
Purpose of the Study:
- To evaluate the safety and patient comfort of allowing clear liquids up to 2-3 hours before anesthesia induction in children undergoing elective cardiac surgery.
Main Methods:
- A comparative study involving two groups of pediatric patients undergoing elective cardiac surgery.
- Study group: permitted ad libitum clear liquids, mandated to drink 2-3 hours before anesthesia.
- Control group: followed routine inpatient preoperative fasting orders.
Main Results:
- No significant difference in mean gastric fluid volume (0.6 vs. 0.4 mL/kg) or proportion of patients with gastric volume >= 0.4 mL/kg (41% vs. 32%) between groups.
- High gastric acidity (pH <= 2.5) was observed in most patients in both groups (95% study vs. 82% control).
- Parents reported significantly greater comfort, less hunger, and less thirst in the study group.
Conclusions:
- Liberalized clear liquid intake 2-3 hours before elective pediatric cardiac surgery is safe regarding gastric volume and acidity.
- This feeding strategy enhances patient comfort without increasing aspiration risk.
Abstract:
The recent liberalization of preoperative feeding orders in healthy pediatric outpatients prompts the question of whether this applies to children about to have cardiac surgery. The authors compared gastric fluid volume and pH in two groups of children undergoing elective cardiac surgery, one of which was not only permitted ad libitum clear liquids but was mandated to drink clear liquids 2-3 h before induction of anesthesia (study group). The other group followed routine inpatient preoperative fasting orders (control group). The study group (n = 44) averaged 3.1 +/- 4.1 yr and weighed 15.3 +/- 16.3 kg; the control group averaged 3.3 +/- 3.9 yr and weighed 14.3 +/- 12.1 kg (P = 0.82, 0.73, respectively). Aspiration of residual gastric fluid volume was attempted in all patients after induction of anesthesia. Gastric fluid volume averaged 0.6 +/- 0.9 mL/kg in the study group and 0.4 +/- 0.6 mL/kg in the control group (P = 0.13). Of the study patients, 41% had a measured gastric volume greater than or equal to 0.4 mL/kg compared with 32% of the control patients (P = 0.50). Of the 42 patients who had residual gastric fluid aspirated, pH determinations were completed on 37 aspirates; of these 19 of 20 (95%) in the study group and 14 of 17 (82%) in the control group had a gastric pH less than or equal to 2.5. Using a linear analogue scale, parents rated children in the study group to be more comfortable, less hungry, and less thirsty compared with the control patients (P = 0.004, 0.002, 0.0001, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)