Preoperative fasting for preventing perioperative complications in children

Brady, Marian; Kinn, Sue; O’Rourke, Keith; Randhawa, N; Stuart, Pauline

doi:10.1002/14651858.cd005285.pub2

Cited by 123 publications

(71 citation statements)

References 84 publications

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“…[7] A metaanalysis of 25 trials found that children who were denied oral fluids for more than 6 h preoperatively did not benefit in terms of intraoperative gastric volume and pH as compared with children who were permitted unlimited fluids up to 2 h preoperatively. [8] ASA, ESA, APAGBI and RCN have formulated liberal guidelines for preoperative fasting in children (2-4-6 rule). [3–6] These guidelines, while assuring appropriate levels of patient safety, have been directed at improving the overall perioperative experience for infants, children and their parents.…”

Section: Discussionmentioning

confidence: 99%

Preoperative fasting in children: An audit and its implications in a tertiary care hospital

Arun

Korula

2013

J Anaesthesiol Clin Pharmacol

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Background:Prolonged preoperative fasting in children is a common problem, especially in highvolume centers. All international professional society guidelines for preoperative fasting recommend 2 h for clear fluids, 4 h for breast milk and 6 h for solids, nonhuman and formula milk in children. These guidelines are rarely adhered to in practice.Aims:An audit was undertaken to determine the length of preoperative fasting time in children and its causes.Settings and Design:Cross-sectional study of 50 children below 15 years posted for elective surgeries.Materials and Methods:An initial audit was performed at our institution on preoperative fasting time in 50 children below 15 years of age for elective surgeries. The mean preoperative fasting times were found to be much longer than the recommended times. Ward nurses were then educated about internationally recommended preoperative fasting guidelines in children. Anesthesiologists started coordinating with surgeons and ward nurses to prescribe water for children waiting for more than 2 h based on changes in surgery schedule by instructing ward nurses through telephone on the day of surgery. A reaudit was done 6 months after the initial audit.Statistical Analysis Used:SPSS 16 software.Results:The initial audit revealed a mean preoperative fasting time of 11.25 h and 9.25 h for solids and water, respectively. Incorrect orders by ward nurses (74%) and change in the surgical schedule (32%) were important causes. After changing the preoperative system, mean preoperative fasting times in children decreased to 9 h and 4 h for solids and water, respectively in reaudit. Change in surgical schedule (30%) was the major cause for prolonged preoperative fasting in reaudit.Conclusions:Simple steps such as education of ward nurses and better coordination among the anesthesiologists, surgeons and nurses can greatly reduce unnecessary preoperative starvation in children.

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Section: Discussionmentioning

confidence: 99%

Preoperative fasting in children: An audit and its implications in a tertiary care hospital

Arun

Korula

2013

J Anaesthesiol Clin Pharmacol

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“…This is because most of them have a liquid stomach content of more than 4 mL/kg at the time of anesthesia, with a pH of less than two, regardless of the fasting interval (Maekawa et al ., 1998). In relation to this, a metaanalysis concluded that children who preoperatively fluid fasted for more than six hours benefit in terms of intraoperative gastric volume and pH when compared to children permitted unlimited fluids up to two hours preoperatively (Brady et al ., 2009). In veterinary anesthesia, the presence of liquid in the stomach of puppies has not been described.…”

Section: Influence Of Breed Body Condition and Age On Ger During Anmentioning

confidence: 99%

Gastroesophageal reflux in anesthetized dogs: a review

Rodríguez-Alarcón

Rivera-Barreno

Díaz

et al. 2015

Rev Colomb Cienc Pecu

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SummaryGastroesophageal reflux can be a catastrophic illness in small animals during anesthesia since its complications can cause serious pathologies, such as esophagitis, esophageal stenosis and aspiration pneumonia. With an incidence from 12 to 78.5% in anesthetized dogs, gastroesophageal reflux is normally silent during anesthesia and will be notices only if regurgitation occurs and stomach acid is present in the nasal or oral cavities. In humans, gastroesophageal reflux disease (GERD) is a well-defined pathology where the lower esophageal sphincter has a sustained weakness. However, in dogs, gastroesophageal reflux disease as such is not well established, if at all; it has only been described as gastroesophagic reflux, occurring principally in anesthetized animals. There are several factors influencing the presentation of reflux in anesthetized dogs, which may be inherent to the patient (e.g. age, sex, breed, weight, or body condition), medications used prior to and during anesthesia, type of surgery or position of the animal during surgery. The objective of this review is to discuss a series of conditions that could predispose dogs to gastroesophageal reflux during anesthesia and to assist in the prevention and diagnosis of this condition.

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“…A systematic review of the Cochrane Database showed that children with liquids up to 120 min before surgery, besides presenting with less thirst and hunger, best behaved and comfortable than those who remained in regular fasting 6 .…”

Section: Discussionmentioning

confidence: 99%

Changing Paradigms in Preoperative Fasting: Results of a Joint Effort in Pediatric Surgery

Carvalho

Carvalho²,

Nogueira

et al. 2017

ABCD, arq. bras. cir. dig.

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Background: Current researches associate long fasting periods to several adverse consequences. The fasting abbreviation to 2 h to clear liquids associated with the use of drinks containing carbohydrates attenuates endocrinometabolic response to surgical trauma, but often is observed children advised to not intake food from 00:00 h till the scheduled surgical time, regardless of what it is. Aim: To evaluate the safety of a protocol of preoperative fasting abbreviation with a beverage containing carbohydrates, and early postoperative feeding in children underwent elective small/mid-size surgical procedures during a national task-force on pediatric surgery. Methods: Thirty-six patients were prospectively included, and for several reasons five were excluded. All 31 who remained in the study received a nutritional supplement containing 150 ml of water plus 12.5% maltodextrin 2 h before the procedure. Data of the pre-operative fasting time, anesthetic complications and time of postoperative refeeding, were collected. Results:Twenty-three (74.2%) were males, the median age was 5 y, and the median weight was 20 kg. The median time of pre-operative fasting was 145 min and the time of post-operative refeeding was 135 min. There were no adverse effects on the anesthetic procedures or during surgery. Post-operatively, two children (6.5%) vomited. Conclusion: The abbreviation of pre-operative fasting to 2 h with beverage containing carbohydrate in pediatric surgery is safe. Early refeeding in elective small/mid-size procedures can be prescribed.

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Preoperative fasting for preventing perioperative complications in children

Cited by 123 publications

References 84 publications

Preoperative fasting in children: An audit and its implications in a tertiary care hospital

Preoperative fasting in children: An audit and its implications in a tertiary care hospital

Gastroesophageal reflux in anesthetized dogs: a review

Changing Paradigms in Preoperative Fasting: Results of a Joint Effort in Pediatric Surgery

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