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Evaluation of Modified Fasting Protocols to Shorten Fasting Time Before Sedation in Children: A Prospective
Eunah Cho1, Jinyoung Song2, June Huh2
1Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Insights
A modified fasting protocol for pediatric patients undergoing sedation for echocardiography is noninferior to the standard protocol. Gastric ultrasound confirmed safety, allowing for potentially shorter fasting times.
Area of Science:
- Pediatric Anesthesiology
- Gastrointestinal Physiology
- Medical Imaging
Background:
- Current fasting guidelines before procedural sedation aim to prevent pulmonary aspiration, particularly for deep sedation.
- This study investigates a shortened fasting protocol's safety and efficacy compared to standard guidelines.
Purpose of the Study:
- To compare a modified (shorter) fasting protocol with the standard protocol in pediatric patients undergoing sedation.
- To evaluate gastric contents using ultrasound to determine noninferiority.
Main Methods:
- Pediatric patients (<3 years) undergoing elective transthoracic echocardiography under sedation were randomized.
- Groups received either standard (4-h) or modified (4-h solid, 1-h water) fasting.
- Gastric ultrasound measured cross-sectional area (CSA) in supine and right lateral decubitus positions (RLDP) at 45° elevation.
Main Results:
- The modified fasting protocol was found to be noninferior to the standard protocol.
- The primary outcome, CSA-RLDP 45, showed a mean difference of 0.16 (-0.55 to 0.87), falling within the noninferiority delta of 2.1.
Conclusions:
- A modified fasting protocol is noninferior to the standard protocol for pediatric patients undergoing sedation for transthoracic echocardiography.
- Gastric ultrasound assessment supports the safety of the modified fasting protocol.
Backgrounds:
Guidelines for fasting before procedural sedation aim to prevent pulmonary aspiration and are primarily targeted for deep sedation. Our study explored whether a shortened fasting protocol is noninferior to the standard protocol by comparing gastric contents evaluated by ultrasound.
Methods:
Pediatric patients aged < 3 years, scheduled for elective transthoracic echocardiography under sedation, were randomly allocated to a standard group (4-h fasting) or a modified group (4-h fasting for solid and 1-h fasting for water). Gastric ultrasound was performed to evaluate cross-sectional area (CSA) in supine and right lateral decubitus positions (RLDP), with the upper body elevated at 45°. The primary outcome was the CSA-RLDP (CSARLDP 45). A noninferiority test was performed applying the delta (Δ) of 2.1.
Results:
The noninferiority test showed that the modified fasting protocol was noninferior to the standard fasting protocol in terms of CSARLDP 45, with a mean difference (95% confidence interval) of 0.16 (-0.55 to 0.87) within the noninferiority range of delta.
Conclusion:
The modified fasting protocol was noninferior to the standard in pediatric patients undergoing sedation for transthoracic echocardiography, as assessed by gastric ultrasound.
Trial Registration:
ClinicalTrials.gov identifier: NCT05810532.
