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Comparison of different preoperative fasting times for pediatric elective surgical procedures: A randomized
Humna Jasarat1, Fatima Naumeri2
1Humna Jasarat, MBBS. Department of Pediatric Surgery, King Edward Medical University/Mayo Hospital, Lahore, Pakistan.
Insights
Liberal fasting in children undergoing elective surgery resulted in slightly higher, though not statistically significant, residual gastric volume and lower gastric pH compared to standard fasting protocols. This suggests potential implications for anesthesia safety in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Surgical Care
Background:
- Pre-operative fasting guidelines aim to minimize residual gastric volume and reduce aspiration risk during anesthesia.
- Standard fasting protocols can be lengthy, potentially causing discomfort and dehydration in pediatric patients.
Purpose of the Study:
- To compare mean residual gastric volume and gastric pH between standard and liberal fasting regimens in children undergoing elective general anesthesia.
- To evaluate the safety and efficacy of shortened fasting periods in pediatric surgical patients.
Main Methods:
- A randomized controlled trial involving 120 children undergoing elective daycare surgery.
- Patients were randomized into standard (6-4-2 hours) and liberal (6-4-1 hour) Nil Per Oral (NPO) groups for solids/formula, breast milk, and clear fluids.
- Residual gastric volume and pH were measured post-anesthesia, with statistical analysis using t-test (p<0.05).
Main Results:
- Mean residual gastric volume was 0.67±0.48 ml in the standard fasting group versus 0.80±0.44 ml in the liberal fasting group (p=0.13).
- Mean gastric fluid pH was 1.72±0.78 in the standard group and 1.63±0.70 in the liberal group (p=0.53).
- While liberal fasting showed a trend towards higher residual volume and lower pH, these differences were not statistically significant.
Conclusions:
- Liberal fasting protocols allow for significantly shorter fasting times in pediatric surgical patients.
- The observed increase in residual gastric volume and decrease in pH with liberal fasting were statistically insignificant, suggesting a potentially safe alternative.
- Further research may be warranted to confirm the safety profile and optimize liberal fasting guidelines in pediatric anesthesia.
Objective:
To compare the mean residual gastric volume and gastric pH with standard and liberal fasting in children undergoing general anesthesia for elective procedures.
Methods:
A randomized controlled trial (NCT05922072) was conducted at Department of Pediatric Surgery, Mayo Hospital Lahore from June 2021 to December 2021 and 120 patients undergoing elective daycare surgical procedures under general anesthesia were enrolled. Patients were divided into Group-A (Standard fasting) and Group-B (Liberal fasting). Group-A with 6-, 4- and 2-hours Nil per oral (NPO) for solids/ formula milk, breast milk and clear fluid, while Group-B with six, four and one hour NPO for solids/ formula milk, breast milk and clear fluid respectively. Residual gastric volume and pH were measured after anesthetizing the patient. Effect modifiers like age, gender, duration of anesthesia and procedure were controlled through stratification. Post-stratification, t-test was applied and p-value less than 0.05 was taken as statistically significant.
Results:
In Group-A, mean age was 6.1±4.5 years and 6.4±4.6 years in Group-B. Mean residual gastric volume with standard fasting was 0.67±0.48 ml and liberal fasting 0.80±0.44 ml (p value 0.13). Mean gastric fluid pH with standard fasting was 1.72±0.78 as compared to liberal fasting 1.63±0.70 (p value 0.53).
Conclusion:
Free fluid fasting allows for significantly shorter fasting times, though statistically insignificant higher residual gastric volume was recorded in liberal fasting group with a lower pH.
