Enhanced recovery after surgery strategy to shorten perioperative fasting in children undergoing non-gastrointestinal surgery: A prospective study

Abstract

BACKGROUND Enhanced recovery after surgery strategies are increasingly implemented to improve the management of surgical patients. AIM To evaluate the effects of new perioperative fasting protocols in children ≥ 3 mo of age undergoing non-gastrointestinal surgery. METHODS This prospective pilot study included children ≥ 3 mo of age undergoing non-gastrointestinal surgery at the Children’s Hospital (Zhejiang University School of Medicine) from January 2020 to June 2020. The children were divided into either a conventional group or an ERAS group according to whether they had been enrolled before or after the implementation of the new perioperative fasting strategy. The children in the conventional group were fasted using conventional strategies, while those in the ERAS group were given individualized fasting protocols preoperatively (6-h fasting for infant formula/non-human milk/solids, 4-h fasting for breast milk, and clear fluids allowed within 2 h of surgery) and postoperatively (food permitted from 1 h after surgery). Pre-operative and postoperative fasting times, pre-operative blood glucose, the incidence of postoperative thirst and hunger, the incidence of perioperative vomiting and aspiration, and the degree of satisfaction were evaluated. RESULTS The study included 303 patients (151 in the conventional group and 152 in the ERAS group). Compared with the conventional group, the ERAS group had a shorter pre-operative food fasting time [11.92 (4.00, 19.33) vs 13.00 (6.00, 20.28) h, P < 0.001), shorter preoperative liquid fasting time [3.00 (2.00, 7.50) vs 12.00 (3.00, 20.28) h, P < 0.001], higher preoperative blood glucose level [5.6 (4.2, 8.2) vs 5.1 (4.0, 7.4) mmol/L, P < 0.001], lower incidence of thirst (74.5% vs 15.3%, P < 0.001), shorter time to postoperative feeding [1.17 (0.33, 6.83) vs 6.00 (5.40, 9.20), P < 0.001], and greater satisfaction [7 (0, 10) vs 8 (5, 10), P < 0.001]. No children experienced perioperative aspiration. The incidences of hunger, perioperative vomiting, and fever were not significantly different between the two groups. CONCLUSION Optimizing fasting and clear fluid drinking before non-gastrointestinal surgery in children ≥ 3 mo of age is possible. It is safe and feasible to start early eating after evaluating the recovery from anesthesia and the swallowing function.

Beyond Guidelines: The Persistent Challenge of Preoperative Fasting Times

“…This research ensured regular surveillance of surgical schedules, pinpointing and mitigating potential delays to avert extended fasting. The authors accentuated the paramountcy of not just introducing a revised fasting protocol but also the thorough training of the medical staff to adeptly apply it, especially given the frequent surgical rescheduling [4].…”

“…In a study with 270 patients, those reminded via text message fast showed a shorter average liquid fasting time (3.5 vs. 6.5 h, p < 0.0001), but solid food fasting remained unchanged. Some patients' reluctance to eat late also potentially influenced fasting periods [4,18,24,25].…”

“…This duration was empirically ascertained to accommodate gastric emptying [2]. Nevertheless, it is now unequivocally recognized that protracted fasting can augment insulin resistance, exacerbate the metabolic response to surgical stress, and correlate with heightened incidences of nausea, vomiting, dehydration, thirst, hunger, anxiety, and, consequentially, elevated morbidity, mortality rates, infections, prolonged hospital stays, and healthcare expenditures [3][4][5][6][7][8][9][10][11][12][13].…”

Procedural sedation in pediatric dentistry: a narrative review

“…According to the updated 2023 ASA guidelines on fasting, include the use of oral midazolam, it is recommended to minimize fasting duration in children. Therefore, every effort should be made to permit clear liquids in healthy children up to 2 h before medical procedures ( 113 ), and that early eating is safe as long as the patients have recovered from anesthesia and swallowing function evaluation is done ( 114 ). It’s important to note that following the ASA fasting guidelines is recommended for patients undergoing moderate sedation, where the child may not be able to maintain verbal contact or may undergo deep sedation.…”

Abreviação Do Tempo De Jejum Pré-Operatório: Revisão Da Literatura

“…Desde então, o conceito tradicional de jejum e privação de água tem sido questionado por anestesistas e cirurgiões após anos de prática. Atualmente, a Sociedade Americana de Anestesiologistas (ASA) e a ERAS Society apresentaram suas opiniões orientadoras, porém nenhum consenso foi alcançado 2 .…”