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[Perioperative fasting in children: current data]
1Département d'anesthésie-réanimation pédiatrique, hôpital d'enfants de la Timone, Marseille, France.
Insights
New guidelines suggest allowing clear fluids until 2-3 hours before surgery for children, reducing fasting time without increasing aspiration risk. Post-surgery, fluid intake is based on the child's assessment, minimizing vomiting.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Gastroenterology
Context:
- Perioperative fasting guidelines aim to reduce pulmonary aspiration risk.
- Prolonged fasting does not ensure gastric emptiness before anesthesia.
- Current practices may cause unnecessary patient discomfort.
Purpose:
- To evaluate new perioperative fasting guidelines for pediatric ambulatory surgery.
- To determine if shortening fasting periods impacts gastric content and aspiration risk.
- To assess the effect of postoperative fluid intake on vomiting incidence.
Summary:
- Allowing clear fluids (water, tea, coffee, clear juices) until 2-3 hours pre-operation is safe for children, with no increased aspiration risk.
- Shortened preoperative fasting enhances patient comfort.
- Postoperative water intake significantly increases vomiting; intake should be child-assessed before discharge.
Impact:
- Revised guidelines can improve pediatric surgical patient comfort.
- Reduced fasting times may lead to better patient outcomes in ambulatory surgery.
- Evidence supports individualized postoperative fluid management to decrease vomiting.
Abstract:
Perioperative fasting aims at decreasing the incidence of gastric content inhalation during anesthesia. Current knowledge concerning gastric emptying and the epidemiology of pulmonary aspiration authorizes new perioperative fasting guidelines. If prolonged fasting does not guarantee gastric emptiness at the induction of anesthesia, shortening preoperative fasting by allowing clear fluids two hours before surgery does not modify gastric content and does not increase the risk of gastric content aspiration, while enhancing the patient comfort by reduction of the fasting period. On the other hand, after surgery, the mandatory intake of water significantly increases the incidence of postoperative vomiting. Therefore new guidelines may be applied for children operated in ambulatory surgery settings: 1) clear fluids may be allowed until 2-3 hours before operation, 10 ml.kg-1, or even ad libitum for some authors (by clear fluids one means water, tea, coffee, apple juice, syrup with water); 2) drinking is not absolutely necessary before discharge from day care surgery unit and should be left to the child's own assessment.