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Impact of early postoperative oral hydration in paediatric patients undergoing elective surgery after general
Mridul Dhar1, Jyoti Rawat1,2, Yashwant S Payal1
1Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, India.
Insights
Early postoperative oral hydration in children undergoing elective surgery is safe and effective. This approach led to lower pain scores and increased parental satisfaction compared to delayed feeding.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pain Management
Background:
- Conventional practice involves prolonged fasting (3-6 hours) post-pediatric surgery.
- Limited evidence exists on the impact of early oral hydration on patient satisfaction.
Purpose of the Study:
- To compare the Face, Legs, Activity, Cry, Consolability (FLACC) score as a surrogate for patient satisfaction in young children receiving early versus delayed postoperative feeding/hydration.
- To evaluate complications, perioperative parameters, and parental satisfaction.
Main Methods:
- A single-blind, randomized trial involving 61 children (aged 1-5 years) undergoing elective surgery.
- Children were randomized to early hydration (EH) within 30 minutes or standard hydration (SH) after 2 hours in the post-anesthesia care unit (PACU).
- The primary outcome was the FLACC score at 1 hour post-PACU arrival.
Main Results:
- The FLACC score at 1 hour was significantly lower in the EH group (1 [0.25-2]) compared to the SH group (2 [1-3]), P=0.028.
- Parental satisfaction was higher in the early hydration group.
- No major complications were observed in either group.
Conclusions:
- Early postoperative oral hydration is efficacious and safe in pediatric patients undergoing elective surgery.
- This contrasts with standard delayed feeding protocols.
- Supports the implementation of early hydration for improved patient outcomes and satisfaction.
Background And Aims:
Early feeding or oral hydration post-surgery in paediatric patients has conventionally not been encouraged, with fasting periods ranging from 3 to 6 h. The primary objective of this study was to compare the Face, Legs, Activity, Cry, Consolability (FLACC) score as a surrogate for patient satisfaction in younger children between those who received early versus delayed postoperative feeding/hydration. Secondary objectives were to compare the incidence of complications, perioperative clinical parameters and parental satisfaction.
Methods:
A single-blind, randomised trial was conducted in children of both genders, aged 1-5 years, undergoing elective surgery. Children were randomly allocated using sealed envelopes to receive either early hydration (EH) within 30 min of arrival to the post-anaesthesia care unit (PACU) or delayed standard hydration (SH) after 2 h. A rescue dose of fentanyl was given if the FLACC score was ≥6 at any time in PACU. The primary outcome was the FLACC score in PACU after 1 h. Statistical tests used were the unpaired t-test for normally distributed data, Mann-Whitney U test for non-normally distributed data and Fisher's exact test for categorical variables. P < 0.05 was considered significant.
Results:
Out of the initially randomised 66 patients, 61 were finally analysed. Demographic and perioperative parameters were similar in both groups. FLACC score after 1 h in PACU was significantly lower in Group EH [1 (0.25-2)] than in Group SH [2 (1-3)] (P = 0.028). Parental satisfaction was higher in Group EH. There were no major complications.
Conclusion:
Early postoperative oral hydration is efficacious and safe compared to standard delayed feeds in children undergoing elective surgery.
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