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Pre-operative fasting in adults and children: clinical practice and guidelines
1Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
Insights
Shorter fasting times before surgery are safe and improve patient well-being. Evidence supports a 1-hour fast for children and carbohydrate loading for adults, reducing physiological stress without increasing aspiration risk.
Area of Science:
- Anesthesiology
- Surgical Patient Care
- Perioperative Medicine
Background:
- Prolonged preoperative fasting is recognized as detrimental to patient well-being and offers no clinical benefit for elective surgeries.
- Established fasting guidelines for solids have remained unchanged, despite evolving evidence.
- Patient hydration and metabolic state significantly impact surgical outcomes and physiological responses.
Purpose of the Study:
- To evaluate the safety and efficacy of modified preoperative fasting protocols in pediatric and adult surgical patients.
- To assess the impact of reduced fasting times and carbohydrate loading on patient well-being and physiological stress.
- To determine the risk of pulmonary aspiration associated with shorter fasting durations.
Main Methods:
- Review of existing evidence supporting modified fasting guidelines for children and adults.
- Analysis of data on the physiological effects of carbohydrate loading prior to anesthesia.
- Assessment of pulmonary aspiration risks in relation to altered fasting protocols.
Main Results:
- A 1-hour fasting period for children is supported by evidence, showing no increased risk of pulmonary aspiration.
- Carbohydrate loading in adults before anesthesia improves hydration and metabolic state, attenuating surgical stress responses like insulin resistance.
- No increased risk of pulmonary aspiration was observed in adults with modified fasting and carbohydrate loading protocols.
Conclusions:
- Modified preoperative fasting, including a 1-hour fast for children and carbohydrate loading for adults, is safe and beneficial.
- These updated protocols enhance patient well-being and mitigate adverse physiological responses to surgery.
- Further research is needed to establish optimal fasting practices for patients with diabetes.
Abstract:
It is widely recognised that prolonged fasting for elective surgery in both children and adults serves no purpose, adversely affects patient well-being and can be detrimental. Although advised fasting times for solids remain unchanged, there is good evidence to support a 1-h fast for children, with no increase in risk of pulmonary aspiration. In adults, a major focus has been the introduction of carbohydrate loading before anaesthesia, so that patients arrive for surgery not only hydrated but also in a more normal metabolic state. The latter attenuates some of the physiological responses to surgery, such as insulin resistance. As in children, there is no increase in risk of pulmonary aspiration. Further data are required to guide best practice in patients with diabetes.
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