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Routine Replacement of Fasting Deficits in Pediatric Ambulatory Anesthesia: A Propensity-Matched Retrospective Cohort
Xiang Sharon Luo1, Mathew Mason2, Shannon Chan2
1Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Wilmington, Delaware, USA.
Paediatric Anaesthesia
|July 13, 2026
Summary
Reducing routine fluid replacement in pediatric anesthesia did not impact intraoperative stability or postoperative recovery. This study suggests that standard fasting deficit calculations may not be necessary for healthy children undergoing short ambulatory procedures.
Area of Science:
- Pediatric Anesthesia
- Intravenous Fluid Therapy
- Perioperative Care
Background:
- Routine replacement of calculated fasting deficits is common in pediatric anesthesia.
- The necessity of formula-based deficit replacement for intraoperative stability and postoperative recovery remains uncertain.
Purpose of the Study:
- To evaluate if reducing routine fasting-deficit replacement affects intraoperative hemodynamic stability or early postoperative recovery in pediatric ambulatory procedures.
Main Methods:
- Retrospective cohort study of 8508 pediatric ambulatory procedures after propensity score matching.
- A natural experiment was created by an institutional reduction in routine fasting-deficit replacement due to an intravenous fluid shortage.
- Primary outcome: intraoperative vasopressor administration; Secondary outcomes: PACU rescue antiemetic use, PACU length of stay, and 24-h ED encounters.
Main Results:
- Mean intraoperative crystalloid administration decreased by 38.1% post-practice change.
- Reduced fluid administration was not associated with increased vasopressor use (aOR 1.13, 95% CI 0.92-1.38).
- No significant differences observed in secondary outcomes, though event rates were low.
Conclusions:
- Substantial reduction in routine fasting-deficit replacement was not linked to increased vasopressor use in children.
- No significant differences in early postoperative recovery were observed.
- Findings suggest routine empiric fasting-deficit replacement may not be beneficial for healthy children undergoing short ambulatory procedures.
