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Impact of an unrestricted clear liquid fasting protocol on pediatric perioperative outcomes: a prospective
Alexander S Mina1, Dimingo Gomez2, Duc T Nguyen3
1Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. alexander.mina@bcm.edu.
Insights
Liberalizing clear-liquid fasting guidelines for children significantly reduced fasting times and improved their perioperative experience. This approach enhanced comfort and lowered anxiety without increasing aspiration risks.
Area of Science:
- Pediatric Anesthesiology
- Surgical Patient Care
- Quality Improvement in Healthcare
Background:
- Traditional preoperative fasting (6-4-2) guidelines aim to minimize aspiration risk in children.
- These guidelines often lead to prolonged fasting, causing discomfort and distress for pediatric patients.
Purpose of the Study:
- To evaluate the impact of progressively liberalizing clear-liquid fasting policies on fasting duration.
- To assess improvements in the perioperative experience for children undergoing surgery.
Main Methods:
- A prospective, four-phase quality-improvement study was conducted in rural Kenya.
- Fasting protocols ranged from standard 6-4-2 guidelines to unrestricted clear-liquid intake.
- Outcomes included fasting time, thirst, hunger, parental satisfaction, anxiety, and aspiration events.
Main Results:
- Median clear-liquid fasting time decreased from 14.0 hours to 1.7 hours (p < 0.001).
- Preoperative anxiety significantly reduced (mYPAS 35.4 to 22.9; p < 0.001), and thirst declined.
- One aspiration event occurred; parental satisfaction showed a positive trend (p=0.06).
Conclusions:
- Reducing preoperative fasting duration enhances pediatric patient comfort and decreases anxiety.
- An unrestricted clear-liquid protocol appears feasible and beneficial for pediatric surgical patients.
- The study suggests potential for improved perioperative care without a significant increase in aspiration events.
Purpose:
Traditional preoperative fasting guidance (6-4-2) aims to reduce aspiration risk but frequently produces prolonged fasting and discomfort in children. We evaluated whether progressively liberalizing the clear-liquid fasting policy reduces fasting time and improves the perioperative experience.
Methods:
We conducted a prospective, four-phase interventional quality-improvement study at a tertiary hospital in rural Kenya (11/2021-12/2022). Phase 0 followed standard 6-4-2 guidelines; Phase 1 shortened clear-liquid fasting to 1 h; Phase 2 permitted a fixed volume of water until transfer to theatre; Phase 3, unrestricted water. The primary outcome was clear-liquid fasting time. Secondary outcomes were thirst, hunger, parental satisfaction, preoperative anxiety, and aspiration events.
Results:
Among 253 children, median clear-liquid fasting time decreased: 14.0 h (Phase 0) to 1.7 h (Phase 3) (p < 0.001). Anxiety decreased significantly (mYPAS 35.4 to 22.9; p < 0.001) and thirst declined. Parental satisfaction was higher but did not reach statistical significance (8.0 to 9.0; p = 0.06). One confirmed aspiration occurred in Phase 1 (7.2-h fasting time).
Conclusion:
Reducing preoperative fasting improved comfort and lowered anxiety. No increase in clinically significant aspiration events was observed, although the study was not powered for rare events. An unrestricted clear-liquid protocol appears feasible and beneficial.