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Ingestion of liquids compared with preoperative fasting in pediatric outpatients
M S Schreiner1, A Triebwasser, T P Keon
1Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Pennsylvania.
Insights
Allowing clear liquids before surgery significantly reduces preoperative irritability in children. This study found no significant difference in gastric fluid volume or acidity, improving the overall patient experience.
Area of Science:
- Pediatric Anesthesiology
- Surgical Patient Care
Background:
- Preoperative fasting in children can lead to discomfort and irritability.
- Current fasting guidelines may not fully address patient experience.
- Clear liquid intake prior to surgery is a potential method to improve comfort.
Purpose of the Study:
- To compare gastric fluid volume and pH in children allowed clear liquids up to 2 hours before surgery versus routine fasting.
- To assess the impact of clear liquid intake on children's preoperative experience and irritability.
Main Methods:
- Two groups of children were studied: one permitted clear liquids (study group) and one with routine fasting (control group).
- Gastric contents were aspirated after anesthesia induction to measure volume and pH.
- Parental ratings using a linear analog scale assessed irritability and overall experience.
Main Results:
- No significant difference in mean gastric fluid volume (0.44 vs. 0.57 ml/kg) or the proportion of patients with volume >= 0.4 ml/kg (48% vs. 58%) between groups.
- High gastric fluid acidity (pH <= 2.5) was observed in 97% of the study group and 92% of the control group.
- Parents reported significantly less irritability (P < 0.001) and a better overall preoperative experience (P < 0.01) for children in the study group.
Conclusions:
- Allowing children to drink clear liquids up to 2 hours before surgery does not increase gastric fluid volume or acidity to a clinically significant degree.
- This practice significantly improves children's preoperative comfort and reduces irritability.
- Clear liquid liberalization is a safe and beneficial strategy for enhancing the pediatric preoperative experience.
Abstract:
The preoperative fast is often an unpleasant preoperative experience that might be alleviated by allowing children to drink clear liquids. The authors compared gastric fluid volume and pH in two groups of children, one of whom was permitted clear liquids until 2 h before surgery (study group) and the other followed routine preoperative fasting orders (control group). The study group was not limited in the quantity of clear liquid allowed with the exception that the last intake prior to surgery was limited to 8 ounces. The study group (n = 53) averaged 5.9 +/- 5 yr and weighed 23.6 +/- 17 kg, while the control group averaged 7.3 +/- 4.6 yr and weighed 29 +/- 17.7 kg (P = NS). Gastric contents were aspirated following induction of anesthesia. Gastric fluid volume averaged 0.44 +/- 0.51 ml/kg for study group and 0.57 +/- 0.51 ml/kg in the control group (P = 0.12). Of the study patients, 48% had a measured gastric fluid volume greater than or equal to 0.4 ml/kg compared with 58% of the control patients (P = 0.77). Eighty three patients had sufficient gastric fluid for pH determination; of these 34/35 (97%) in the study group and 44/48 (92%) in the control group had a gastric fluid pH less than or equal to 2.5. Using a linear analog scale parents rated the children in the study group to be less irritable (P less than 0.001) and to have had a better overall preoperative experience (P less than 0.01) compared with the control patients.(ABSTRACT TRUNCATED AT 250 WORDS)