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Withholding oral fluids from children undergoing day surgery reduces vomiting
R Kearney1, C Mack, L Entwistle
1Department of Anaesthesia, University of Alberta, Edmonton, Canada.
Insights
Withholding oral fluids for 4-6 hours after day surgery significantly reduces postoperative vomiting in children. This simple intervention lowers vomiting rates, especially for patients receiving opioids.
Area of Science:
- Pediatric Anesthesiology
- Surgical Patient Care
Background:
- Postoperative vomiting (POV) is a common complication in children undergoing day surgery.
- Managing POV is crucial for patient comfort and efficient hospital throughput.
Purpose of the Study:
- To evaluate the impact of withholding oral fluids postoperatively on the incidence of POV in pediatric day surgery patients.
- To determine if fluid restriction is an effective strategy for reducing POV.
Main Methods:
- A randomized controlled trial involving 317 children undergoing day surgery.
- Patients were assigned to either receive oral fluids or have them withheld for 4-6 hours postoperatively.
- Intravenous fluids were administered to meet anticipated fasting needs. Vomiting incidence was tracked through postoperative day one.
Main Results:
- The group with withheld oral fluids had a significantly lower incidence of vomiting (38%) compared to the group that drank fluids (56%) (P < 0.004).
- This reduction was observed across all patients, including those at high risk for POV (e.g., strabismus, adenoidectomy +/- tonsillectomy).
- The most significant reduction in vomiting occurred in patients receiving opioids, with rates dropping from 73% to 36% (P < 0.001).
Conclusions:
- Withholding oral fluids for a defined period postoperatively is an effective method to decrease the incidence of vomiting in children undergoing day surgery.
- This strategy offers a practical approach to managing POV, particularly in conjunction with opioid analgesia.
Abstract:
The effect of withholding oral fluids on the incidence of postoperative vomiting was evaluated in 317 children undergoing day surgery. Children were randomized by cohort into one of two groups either drinking oral fluids or having oral fluids withhold for 4-6 h postoperatively. All patients received replacement intravenous fluids sufficient to cover the anticipated fasting period. Vomiting was assessed in hospital through to the first postoperative day. Compliance to the protocol was excellent. The incidence of vomiting in the group with fluids withheld was significantly less than (P < 0.004) that of the group which drank (38% vs 56%). This difference was seen whether or not patients thought to be at high risk for postoperative vomiting (strabismus or adenoidectomy +/- tonsillectomy) were included in the analysis. The greatest effect of withholding oral fluids was seen in patients receiving opioids (P < 0.001) where vomiting was reduced from 73% to 36%. Withholding oral fluids postoperatively from children undergoing day surgery reduces the incidence of vomiting.