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Published on: September 22, 2023
Effect of Preoperative Clear Liquid Consumption on Postoperative Recovery in Pediatric Patients Undergoing Minimally
Jaewon Huh1, Jung-Min Koo1, Minju Kim1
1Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Insights
Allowing children to drink clear liquids before surgery for pectus excavatum (MIRPE) significantly reduces emergence delirium (ED) and postoperative pain compared to traditional overnight fasting (NPO). This supports updated preoperative fasting guidelines for pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Surgical Outcomes Research
- Pediatric Surgery
Background:
- Traditional preoperative fasting guidelines aim to minimize pulmonary aspiration risk.
- Prolonged fasting in children can lead to adverse effects.
- Investigating alternatives to prolonged fasting is crucial for pediatric surgical care.
Purpose of the Study:
- To evaluate the impact of preoperative clear liquid intake on postoperative outcomes in pediatric patients.
- Specifically assess the effects on emergence delirium (ED) and pain management.
- Examine outcomes in children undergoing minimally invasive repair of pectus excavatum (MIRPE).
Main Methods:
- A prospective randomized controlled study involving children aged 3-6 years undergoing MIRPE.
- Patients were randomized into two groups: routine overnight fasting (NPO) or clear liquid intake.
- Emergence delirium assessed using Pediatric Anesthesia Emergence Delirium (PAED) and Watcha scales; pain scores and opioid requirements were monitored postoperatively.
Main Results:
- The clear liquid group experienced significantly shorter fasting times compared to the NPO group.
- Lower incidence and severity of emergence delirium (ED) were observed in the clear liquid group (PAED score ≥ 12: 55.6% vs. 85.2%; Watcha score ≥ 3: 51.9% vs. 85.2%).
- Clear liquid consumption correlated with reduced postoperative pain scores and lower opioid requirements.
Conclusions:
- Preoperative clear liquid intake is associated with a reduced incidence of emergence delirium in pediatric patients undergoing MIRPE.
- This practice may improve overall postoperative recovery and patient comfort.
- Findings support revising preoperative fasting protocols for pediatric surgical procedures.
Abstract:
Background/Objectives: Preoperative fasting guidelines traditionally aim to reduce pulmonary aspiration risk. However, concerns over the adverse effects of prolonged fasting have led to exploring alternatives. This study aimed to investigate the impact of preoperative clear liquid intake on postoperative outcomes in children undergoing minimally invasive repair of pectus excavatum (MIRPE). Methods: A prospective randomized controlled study was conducted on children aged 3-6 years scheduled for elective MIRPE. Patients were randomized into either a routine overnight fasting group (NPO) or a clear liquid group. The incidence and severity of emergence delirium (ED) were assessed using Pediatric Anesthesia Emergence Delirium (PAED) and Watcha scales at recovery room. Postoperative pain scores and opioid requirements were evaluated at intervals of 1-6 h, 6-12 h, and 12-24 h after surgery. Results: Fasting time was 178.6 ± 149.5 min and 608.9 ± 148.4 min in the clear liquid group compared and NPO group, respectively. The incidence of ED, measured by PAED and Watcha scales, was lower in the clear liquid group (PAED score ≥ 12: 55.6% vs. 85.2%, p = 0.037; Watcha score ≥ 3: 51.9% vs. 85.2%, p = 0.019). The highest PAED score recorded in the recovery room was significantly lower in the clear liquid group (11.4 ± 2.8 vs. 14.6 ± 2.8, p < 0.001). Clear liquid group showed significantly lower pain scores at 1-6, 6-12, and 12-24 h postoperatively. Additionally, clear liquid group had lower opioid requirement at 1-6 and 6-12 h postoperatively. Conclusions: Preoperative clear liquid consumption was associated with a lower incidence of ED in pediatric patients undergoing MIRPE.
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