Preoperative fasting in children. The evolution of recommendations and guidelines, and the underlying evidence

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Critical Care Medicine

Background:

• Preoperative fasting guidelines aim to minimize pulmonary aspiration risk during anesthesia.
• Established guidelines for pediatric patients have evolved slowly over recent decades.
• Pulmonary aspiration remains a significant concern in pediatric anesthesia.

Purpose of the Study:

• To review the evolution of preoperative fasting guidelines in pediatric anesthesia.
• To examine the incidence and risk factors of pulmonary aspiration in children.
• To assess the impact of fasting duration on aspiration risk.

Main Methods:

• Systematic review of nine professional society guidelines published since 1994.
• Analysis of twelve studies reporting the incidence of pulmonary aspiration in pediatric patients.
• Identification of risk factors associated with pulmonary aspiration.

Main Results:

• Preoperative fasting recommendations for pediatric anesthesia have shown minor adaptations over 30 years.
• The incidence of pulmonary aspiration in children ranges from 0.6 to 12 per 10,000 anesthetics.
• Emergency surgery, ASA physical status, and patient age are primary risk factors for aspiration.

Conclusions:

• Current pediatric preoperative fasting guidelines have seen limited evolution.
• The duration of clear fluid fasting is not significantly associated with increased pulmonary aspiration risk.
• Future guideline updates may reflect the safety of shorter clear fluid fasting durations.