Thirsty work: Exploring children's experiences of preoperative fasting

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.

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.

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.

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.

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.