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Preoperative fasting in children
1Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories.
Insights
New pediatric preoperative fasting guidelines allow clear fluids up to 2-3 hours before anesthesia, reducing thirst and irritability in healthy children. This practice does not increase aspiration risk, but vigilance is needed with laryngeal mask airways.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Current pediatric preoperative fasting guidelines are based on outdated knowledge.
- Aspiration pneumonitis is a significant risk in pediatric anesthesia, though actual incidence is low.
- Healthy children have a high potential risk for aspiration (60-75%).
Purpose of the Study:
- To review and update pediatric preoperative fasting guidelines.
- To assess the safety and efficacy of allowing clear fluids up to 2-3 hours before anesthesia in children.
- To provide clear instructions for parents regarding preoperative fasting.
Main Methods:
- Review of current literature and recent investigations on pediatric preoperative fasting.
- Comparison of aspiration risk between conventional fasting and allowing clear fluids.
- Clinical judgment for identifying high-risk pediatric patients.
Main Results:
- Allowing clear fluids up to 2-3 hours before anesthesia does not increase aspiration risk in healthy children.
- Children are less thirsty and irritable with the updated fasting regimen.
- Reduced incidence of hypoglycemia and hypovolemia in infants is possible.
- Laryngeal mask airway (LMA) does not offer the same airway protection as an endotracheal tube.
Conclusions:
- Updated guidelines allowing clear fluids 2-3 hours before anesthesia are safe for healthy children.
- Simple, explicit preoperative fasting instructions are beneficial for parents, especially in day-case settings.
- Careful clinical assessment is crucial for identifying and managing high-risk pediatric patients.
- Constant vigilance is required when using LMAs in children due to aspiration risks.
Abstract:
The development of new preoperative fasting guidelines in paediatrics was reviewed in the light of present knowledge and some recent investigations. Although the proportion of healthy children with the potential risk of aspiration pneumonitis is relatively high (60-75%), the incidence of aspiration is low--1 to 8.6 in 10,000. In healthy children, there is no increase in the risk of aspiration by allowing them to drink clear fluids up to 2-3 hours before anaesthesia when compared with the conventional fasting regimen. The children are less thirsty and less irritable. The occurrence of hypoglycaemia and hypovolaemia in small infants may also be reduced. However, it is essential to identify high risk cases by clinical judgement and to treat them differently in their management. It is useful to have simple and explicit preoperative fasting instructions for parents to follow, especially in the day case setting. It is essential to note that the laryngeal mask airway (LMA) does not protect the patient's airway against the risk of regurgitation and aspiration of gastric contents in the same way as an endotracheal tube. Hence, constant vigilance is required when LMA is used in children.