Thirsty work: Exploring children's experiences of preoperative fasting
Arwa Mohammed Al-Robeye1,2, Anna Nicole Barnard1,2, Stephanie Bew1
1Department of Pediatric Anaesthesia, Leeds General Infirmary, Leeds, UK.
Insights
Pediatric patients undergoing surgery often fast for prolonged periods, exceeding recommended guidelines. This extended preoperative fasting negatively impacts children
Area of Science:
- Pediatric Anesthesiology
- Perioperative Care
- Patient Experience Research
Background:
- Current preoperative fasting guidelines recommend 6 hours for solids, 4 hours for breast milk, and 2 hours for clear fluids to minimize aspiration risk during general anesthesia.
- Previous research indicates that pediatric patients frequently exceed these recommended fasting durations, potentially leading to adverse perioperative outcomes and discomfort.
Purpose of the Study:
- To investigate the actual preoperative fasting durations experienced by pediatric patients undergoing elective surgery.
- To explore the subjective experiences and emotional impact of preoperative fasting on pediatric patients.
- To identify factors influencing prolonged preoperative fasting in children.
Main Methods:
- A prospective, mixed-methods study conducted at Leeds General Infirmary.
- Inclusion of 71 parent surveys and 48 child surveys (for children over six) utilizing visual Likert scales and free-text responses.
- Unique collection of children's direct feedback on their preoperative fasting experience.
Main Results:
- Mean fasting times significantly exceeded guidelines: 11.7 hours for food and 6.9 hours for fluids.
- Prolonged fasting negatively affected patient experience, with 34% reporting significant hunger and 19% significant thirst.
- While most children coped well, some reported negative emotional effects, including sadness and anxiety.
Conclusions:
- Pediatric preoperative fasting durations in clinical practice substantially exceed international recommendations.
- The extended fasting periods contribute to negative patient experiences, including significant hunger, thirst, and emotional distress.
- Optimization of preoperative fasting protocols is crucial to enhance the well-being and experience of pediatric surgical patients.
Background:
Preoperative fasting is performed to reduce aspiration risk during general anesthesia. Recommendations are that patients should fast for 6 hours from solids and nonhuman milk, 4 hours from breast milk, and 2 hours from clear fluids. However, previous studies have shown that children fast far in excess of these times, which can result in perioperative complications and unnecessary discomfort for the child.
Aims:
This prospective, mixed-methods study aims to explore the experiences of pediatric patients undergoing preoperative fasting in Leeds General Infirmary. It also aims to investigate fasting durations of these patients and factors which influence these.
Methods:
Over 2 weeks, surveys were distributed to all parents of elective pediatric patients and completed prior to their child being called to theater. Children over the age of six were offered a child survey, which had been specifically developed for the study, with visual Likert scales and an area for free text. The gathering of children's comments about their experience of preoperative fasting is unique to this study.
Results:
Seventy-one parent surveys and 48 child surveys were completed, with a mean patient age of 8.3 years (SD 4.1). The mean preoperative fasting time for food was 11.7 hours (SD 4.4) and 6.9 hours (SD 5.0) for fluids. Fasting times were far in excess of the minimums recommended, negatively impacting patient experience with 34% reporting being hungry/very hungry and 19% thirsty/very thirsty. Most children's comments suggested that they coped well with the fasting; however, several children reported feelings of sadness and anxiety.
Conclusion:
Preoperative fasting times in pediatric patients far exceed the durations set by international guidelines. Given that many children reported extreme feelings of hunger and thirst or emotional effects from the fast, these durations need to be optimized in order to improve patient experience.
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