Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved?

Abstract

Background: The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes for prolonged NPO times with the aim to suggest improvement strategies by a newly founded fasting task force.Methods: Data from all electronic anesthesia records from 2019 at our institution were reviewed for fasting times. Our NPO instructions follow American Society of Anesthesiology guidelines and are calculated based on the patient’s arrival time (90 min before OR time). Primary outcome was the effective NPO time for clear liquids, secondary outcomes were incidence of delays and the parental compliance with the NPO instructions. Data are presented as median (interquartile range).Results: 9,625 cases were included in the analysis. NPO time was documented in 72.1% with a median effective NPO time of 7:13 h (7:36). OR in room times were documented in 72.8%, 2,075 (29.5%; median time 0:10 h [0:21]) were earlier and 4,939 (70.5%; median time 0:29 h [0:54]) were later than scheduled. Parental NPO compliance showed a median deviation for clear liquid intake of 0:55 h (8:30).Conclusions: This study revealed that effective NPO times were longer than current ASA guidelines. Contributing causes include case delays and parental non-compliance to NPO instructions. Thus, task force recommendations include change NPO instruction calculations to scheduled OR time versus arrival time, and encourage parents to give their child clear liquids at the instructed time.

ERAS in Tonsil Adenoid Surgery in Children

“…However, the problem of the separation of theory and practice lies. Fasting time from drinking is di cult to control accurately, and most of the time there is a delay, mainly due to parental concerns, and surgical anesthesia departmental articulation (9,13). In A J Kouvarellis' study, it was similarly found that there was a large discrepancy between clinical and guidelines and that systematic quality improvement was needed to make it possible to reduce the discrepancy (14).…”

Exploring the Preoperative Fasting and Perioperative Hemodynamic variability in Elective Surgery Under General Anesthesia

“…16 Its significance can be distilled into aspects such as safeguarding organ functionality, ensuring anesthesia safety, guiding effective medical care, optimizing surgical precision, accelerating postoperative recovery, diminishing morbidity and mortality, fortifying infection control. 13,17 All patients scheduled for surgery should be monitored, but the degree of monitoring can vary. Hemodynamically stable patients require maybe nothing more than continuous electrocardiographic (ECG) monitoring, regular non-invasive blood pressure measurement, and peripheral pulse oximetry (Spo2).…”

The thirst for improvement: ensuring shorter and safer pre‐operative fasting times in children

“…Further, Schmidt et al. highlighted how wordings for a ‘nil by mouth’ instruction can lead to parents fasting children for longer than necessary, due to worries about surgery being cancelled [22]. Changing the instruction from punitive statements to those of encouragement, and highlighting the benefit of following the advice closely, can improve parent's understanding and engagement.…”