The risk of shorter fasting time for pediatric deep sedation

Abstract

Background:Current guidelines adopted by the American Academy of Pediatrics calls for prolonged fasting times before performing pediatric procedural sedation and analgesia (PSA). PSA is increasingly provided to children outside of the operating theater by sedation trained pediatric providers and does not require airway manipulation. We investigated the safety of a shorter fasting time compared to a longer and guideline compliant fasting time. We tried to identify the association between fasting time and sedation-related complications.Methods:This is a prospective observational study that included children 2 months to 18 years of age and had an American Society of Anesthesiologists physical status classification of I or II, who underwent deep sedation for elective procedures, performed by pediatric critical care providers. Procedures included radiologic imaging studies, electroencephalograms, auditory brainstem response, echocardiograms, Botox injections, and other minor surgical procedures. Subjects were divided into two groups depending on the length of their fasting time (4–6 h and >6 h). Complication rates were calculated and compared between the three groups.Results:In the studied group of 2487 subjects, 1007 (40.5%) had fasting time of 4–6 h and the remaining 1480 (59.5%) subjects had fasted for >6 h. There were no statistically significant differences in any of the studied complications between the two groups.Conclusions:This study found no difference in complication rate in regard to the fasting time among our subjects cohort, which included only healthy children receiving elective procedures performed by sedation trained pediatric critical care providers. This suggests that using shorter fasting time may be safe for procedures performed outside of the operating theater that does not involve high-risk patients or airway manipulation.

Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists

“…Out of a total of 149046 sedation procedures evaluated for the incidence of aspiration,[ 262 263 264 265 266 ] only one study reported aspiration events (10 instances) (LOE – Low),[ 262 ] while other four studies found no instances of aspiration in any of the children despite many children not meeting the standard fasting criteria prior to procedural sedation (LOE – Low). [ 263 264 265 266 ] Overall, 30,306 children did not meet standard fasting criteria out of 148935 known cases of fasting duration (LOE – Low). [ 262 263 264 265 266 ] A survey among Canadian paediatric emergency departments reported that only 53% physicians follow standard fasting guidelines for children undergoing procedural sedation.…”

“…[ 263 264 265 266 ] Overall, 30,306 children did not meet standard fasting criteria out of 148935 known cases of fasting duration (LOE – Low). [ 262 263 264 265 266 ] A survey among Canadian paediatric emergency departments reported that only 53% physicians follow standard fasting guidelines for children undergoing procedural sedation. The physicians were less likely to perform procedural sedation immediately if a child had a full meal < 2 hours ago or liquids < 1 hour ago.…”