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Impact of preoperative fasting duration on perioperative complications in elective paediatric procedures: a

Tanvi Dabke1, Timothy E Scott2, Ben Taylor3

  • 1Southampton General Hospital, University Hospital Southampton NHS Trust, Southampton, UK.

British Journal of Anaesthesia
|November 28, 2025
PubMed

Insights

Shortening preoperative clear fluid fasting to one hour in children undergoing anaesthesia does not increase aspiration risk. This systematic review found liberal fasting regimens are safe and practical for paediatric patients.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Evidence-Based Medicine

Background:

  • Standardized preoperative fasting in children (2-h clear fluids) aims to prevent aspiration.
  • Current regimens can lead to prolonged fasting, causing adverse effects.
  • Evidence on risks/benefits of shorter fasting in children is limited.

Purpose of the Study:

  • To systematically review randomized controlled trials (RCTs) on preoperative fasting times in pediatric anesthesia.
  • To assess the impact of shorter vs. longer fasting periods on clinical outcomes.

Main Methods:

  • Systematic search of major medical databases (MEDLINE, Embase, Web of Science, CINAHL, Cochrane CENTRAL) up to August 2024.
  • Inclusion of 8 RCTs involving 1234 pediatric patients.
  • Meta-analysis of gastric residual volume and pH, with risk of bias assessment.

Main Results:

  • No significant difference in gastric residual volume or pH between shorter and longer fasting groups.
  • Shorter fasting times were associated with equivalent or reduced postoperative nausea, vomiting, thirst, and hunger.
  • No increased risk of pulmonary aspiration with clear fluid fasting ≤1 hour.

Conclusions:

  • Liberal preoperative clear fluid fasting regimens (≤1 hour) are safe and practical for pediatric anesthesia.
  • Findings support shorter fasting to improve patient comfort and reduce adverse outcomes.
  • Further RCTs and audits are recommended to strengthen evidence.
Abstract

Keywords:
aspirationfastingpaediatric anaesthesiaperioperative complicationspreoperativeregurgitation

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