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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.
Insights
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.
Background:
Routine replacement of calculated fasting deficits is common during pediatric anesthesia, but it remains uncertain whether formula-based deficit replacement is necessary to maintain intraoperative stability or postoperative recovery.
Aims:
We aimed to evaluate whether reducing routine fasting-deficit replacement adversely affected intraoperative hemodynamic stability or early postoperative recovery in pediatric ambulatory procedures.
Methods:
We conducted a retrospective cohort study of 9640 pediatric ambulatory procedures at a tertiary children's hospital (May 2024-March 2025), of whom 8508 were included after propensity score matching (4254 per group). A national intravenous fluid shortage prompted an institution-wide reduction in routine fasting-deficit replacement, creating a natural experiment independent of clinician preference. The primary outcome was intraoperative vasopressor administration; secondary outcomes included post-anesthesia care unit (PACU) rescue antiemetic use, PACU length of stay, and emergency department encounters within 24 h.
Results:
Mean intraoperative crystalloid administration decreased by 38.1% following the practice change. Reduced fluid administration was not associated with increased vasopressor use (adjusted OR 1.13, 95% CI 0.92-1.38). Secondary outcomes-PACU rescue antiemetic use (adjusted OR 0.44, 95% CI 0.13-1.43), PACU length of stay (mean difference -0.7 min), and emergency department encounters within 24 h (adjusted OR 0.53, 95% CI 0.21-1.32)-did not differ between groups, though event rates were low and the study was not powered to detect differences in these outcomes. The confidence interval for the primary outcome does not exclude a clinically meaningful increase in vasopressor use; statistical non-significance should not be interpreted as equivalence.
Conclusions:
In children undergoing ambulatory procedures, a substantial reduction in routine fasting-deficit replacement was not associated with increased vasopressor use, and no important differences were observed in early postoperative recovery. These findings did not identify a clear benefit of routine empiric fasting-deficit replacement in otherwise healthy children undergoing short ambulatory procedures.
