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Preoperative fasting for paediatric anaesthesia
S Phillips1, A K Daborn, D J Hatch
1Hospital for Sick Children, London.
Insights
Reducing preoperative fluid fasting to 2 hours for pediatric surgical patients is safe and beneficial. This practice minimizes risks like aspiration pneumonitis while improving patient comfort and outcomes.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Preoperative fasting guidelines aim to prevent aspiration pneumonitis.
- Traditional fasting periods for solids (6 hours) and fluids are debated for pediatric patients.
- Evidence suggests shorter fluid fasting may be safe and beneficial.
Purpose of the Study:
- To evaluate the safety and efficacy of reduced preoperative fluid fasting in pediatric surgical patients.
- To compare the risk of aspiration pneumonitis with shorter vs. longer fluid fasting durations.
- To identify potential benefits of reduced fluid fasting.
Main Methods:
- Review of existing evidence supporting reduced preoperative fluid fasting.
- Analysis of studies allowing clear fluids up to 2 hours before anesthesia.
- Comparison of gastric content risk between different fasting durations.
Main Results:
- Allowing clear fluids until 2 hours before anesthesia shows similar aspiration risk to longer fasts.
- Reduced fasting may lead to decreased thirst, improved perioperative experience, and reduced hypoglycemia.
- Special consideration is needed for high-risk patients (e.g., GER, emergency surgery).
Conclusions:
- Shortening preoperative fluid fasting to 2 hours is supported by evidence for elective pediatric surgical patients.
- This practice offers potential benefits without increasing aspiration pneumonitis risk.
- Continued careful reporting of complications is essential.
Abstract:
Preoperative fasting was introduced to reduce the risk and severity of aspiration pneumonitis. Adequate time (6h) must still be allowed before operation for solid foods to be emptied from the stomach. However, the overwhelming weight of evidence supports the practice of reducing the duration of the preoperative fluid fast for elective paediatric surgical patients [3, 15]. In children allowed free, clear fluids until 2 h before the scheduled time of anaesthesia, gastric contents and thus the risk of aspiration pneumonitis appears to be similar to those children who have endured a longer fast. Potential benefits of reduced thirst, better perioperative experience, improved compliance and reduced hypoglycaemia may be seen. Patients at risk of GOR and aspiration pneumonitis, including those presenting for emergency surgery, must receive special consideration. As aspiration pneumonitis is so rare, careful reporting of complications potentially related to a reduced fasting period is necessary.