A Study of Preoperative Fasting in Infants Aged Less than Three Months

Abstract

The effects of preoperativefasting on plasma glucose and gastric emptying was studied in 62 infants aged less than three months after a feed of either breast milk or an infant milk formula. Prior to induction of anaesthesia no infant was hypoglycaemic, defined as plasma glucose < 2.2 mmolll. Five per cent of infants had a significant volume of residual gastric contents. The mean intraoperative plasma glucose levels rose significantly and this was not influenced by the use of intravenous H artmann's solution or low dose opioids. Infants in this age group tolerate three-to four-hour preoperative fasts well as no infant became hypoglycaemic intraoperatively. They demonstrate a hyperglycaemic response to the stress of anaesthesia and surgery, and may not need routine intraoperative glucose supplements although plasma glucose should still be monitored.

ABM Clinical Protocol #25: Recommendations for Preprocedural Fasting for the Breastfed Infant: “NPO” Guidelines

“…Newborns have impaired gluconeogenesis, so it is important to offer frequent feeding. 24,25 Up to 2 hours prior to anesthesia, a clear sucrose/electrolyte-based solution can be provided to the newborn. Aside from providing a safer form of volume and calories during a preprocedure fast from HBM, clear liquids ad libitum up to 2 hours prior to a procedure allow for greater infant comfort and less irritability.…”

“…Waking the child to feed 4 hours prior to the scheduled procedure decreases the risk for hypoglycemia and hemodynamic instability, especially in children less than 3 months old (II-1). 24,25 This optimizes the infant's glycogen stores and volume status because the infant might otherwise sleep through the night and not receive optimal nutrition or hydration prior to the scheduled surgery or procedure. Continue clear liquids until 2 hours prior to anesthesia.…”

“…Ad libitum clear liquids up to 2 hours prior to anesthesia or sedation are recommended (III). 17,[19][20][21][22][23]25,[34][35][36] They are considered safe up to 2 hours prior because they empty from the stomach much more rapidly than HBM. They can prevent volume depletion, improve glycogen stores, and maximize hemodynamics by hydrating the infant.…”

“…39,40 If accepted by the infant and allowed by the mother, pacifiers (dummies) are an inexpensive and temporary way to relieve anxiety and improve the infant's comfort and physiologic status (I). [25][26][27][28][29] Please refer to the Academy of Breastfeeding Medicine Clinical Protocol #23 for further information on comforting an infant with a pacifier and sucrose. 26 If possible, express and store breastmilk during the NPO period.…”

Nicht-Nüchternheit vor OP

“…Im Gegensatz zu klaren Flüssigkeiten zeigt Milch eine verlängerte gastrale Passagezeit, was darauf zurückgeführt wird, dass Milch die gastrale Sekretion stimuliert und so das gastrale Volumen erhöht [9]. Auf dieser Beobachtung beruht die Empfehlung einer vierstündigen Nahrungskarenz für Säuglinge nach der Gabe von Muttermilch [11] und von sechs Stunden nach Trinken von Kuhmilch [12].Wegen der verlängerten gastralen Passage für feste Nahrung und wegen des schweren Krankheitsverlaufs nach Aspiration von Nahrungspartikeln, sollte vor einem elektiven Eingriff eine mehr als sechs-…”