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Han L, Wang Y, Zhong J, Zhang M, Li W, Zhou Y, Yao N, Zhang L, Dou X, Wang X. The current state and implications of pre-operative fasting time in children: a systematic review and meta-analysis. Pediatr Surg Int 2025; 41:108. [PMID: 40205229 DOI: 10.1007/s00383-025-06004-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2025] [Indexed: 04/11/2025]
Abstract
Previous clinical practice suggests that prolonged fasting could negatively impact their hemodynamic stability and lead to children's dissatisfaction with the perioperative experience. Fasting guidelines for children are frequently updated. This study aims to explore the status of pre-operative fasting time in children and observe the practice of guidelines in clinical practice. A comprehensive search was conducted until 27 March 2024 in English. We used Stata14.0 for meta-analysis. We used the JBI cross-sectional study quality assessment tool to evaluate the quality. We applied a random effects model to conduct a separate meta-regression analysis on the age and the sample size. Our meta-analysis included 10 studies, with 1694 and 3527 children respectively included in solid and liquid fasting time. The effect magnitude of pre-operative solids fasting time was 12.694 [95% confidence interval (CI), 11.962-13.426, I2: 94.2%, p = 0.001], and the liquid fasting time was 8.379 (95% CI, 6.031-10.727, I2: 99.7%, p < 0.001), both exceedingly greater than twice the recommended time in the guidelines. The duration of preoperative fasting in children differs significantly from international guidelines, and evidence-based improvements are needed in clinical practice. Future research should focus on existing obstacles and how to address them.
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Affiliation(s)
- Leyao Han
- School of Nursing, Lanzhou University, Lanzhou, China
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, China
| | - Yingqiao Wang
- School of Nursing, Lanzhou University, Lanzhou, China
- Department of Cardiovascular Medicine, Lanzhou University Second Hospital, Lanzhou, China
| | - Juanping Zhong
- Department of Outpatient, Lanzhou University Second Hospital, Lanzhou, China
| | - Meishan Zhang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Weiping Li
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yihan Zhou
- Lanzhou University Second School of Clinical Medicine, Lanzhou, China
| | - Nan Yao
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Liping Zhang
- Department of Liver Diseases Branch, Lanzhou University Second Hospital, Lanzhou, China
| | - Xinman Dou
- School of Nursing, Lanzhou University, Lanzhou, China.
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, China.
| | - Xinglei Wang
- School of Nursing, Lanzhou University, Lanzhou, China.
- Department of Cardiovascular Medicine, Lanzhou University Second Hospital, Lanzhou, China.
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Huang Y, Tai J, Nan Y. Effect of fasting time before anesthesia on postoperative complications in children undergoing adenotonsillectomy. EAR, NOSE & THROAT JOURNAL 2024; 103:711-716. [PMID: 35179401 DOI: 10.1177/01455613221078344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Although the guidelines clearly recommend the fasting time of children before anesthesia, it is usually difficult to control. For pediatric patients, prolonged fasting time before surgery will lead to dehydration and hypoglycemia. Adenotonsillectomy is one of the most common operations in pediatric patients, but its complications are not rare. The purpose of this study is to analyze the relationship between preoperative fasting time and postoperative complications in children undergoing adenotonsillectomy. METHODS The medical and surgical records of 480 pediatric patients who underwent adenotonsillectomy were analyzed retrospectively. They were divided into three groups, including adenoidectomy group, tonsillectomy group, and adenotonsillectomy group. Logistic regression analysis was used to analyze the effect of preoperative fasting time on postoperative complications and hospital stay in pediatric patients of the three groups. RESULTS The postoperative bleeding rate in the adenoidectomy group (5.16%) was lower than tonsillectomy group and adenoidectomy group (P < .001). Logistic regression analysis showed that the fasting time was positively correlated with the vomiting and pain in adenoidectomy group, tonsillectomy group, and adenotonsillectomy group. And, the postoperative hospital stay was also positively correlated with fasting time in three groups. CONCLUSION The prolonged fasting time before otolaryngology surgery in children is related to the occurrence of postoperative complications like vomiting and pain, and also to the increase of postoperative hospital stay.
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Affiliation(s)
- Yonghao Huang
- Department of Anesthesiology, Yanbian University Hospital, Yanji, PR China
| | - Junhu Tai
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Yongshan Nan
- Department of Anesthesiology, Yanbian University Hospital, Yanji, PR China
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Webb AR, Kalam I, Lui N, Loughnan RM, Leong S. A pre and post interventional audit of an 'apple juice on arrival' protocol to reduce excessive clear fluid fasting times in paediatric patients. Anaesth Intensive Care 2024; 52:328-334. [PMID: 39212180 DOI: 10.1177/0310057x241263112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Many studies have reported prolonged fasting times in children, associated with negative metabolic and behavioural outcomes. We felt that although our paediatric preoperative clear fluid fasting guideline was only for 2 hours, prolonged fasting still occurred for some patients. We conducted an audit of paediatric fasting times, before and after introducing a new protocol of 'apple juice on arrival', in which, on arrival to the children's ward, all children received 3 ml/kg of apple juice. Data were collected prospectively from patients and their parents for two 4-week periods (before and after introduction of the protocol). Data included fasting time (solids and clear fluids), capillary blood glucose levels, knowledge of fasting requirements and sources of fasting information before surgery. Thirty-nine and 40 children, respectively, were included in each group before and after protocol introduction. Clear fluid fasting times reduced from an average of 9.9 hours pre-intervention to 3.5 hours post intervention (P < 0.01). In addition, mean preoperative blood sugar levels increased from 4.9 mmol/L (pre-intervention group) to 5.6 mmol/L in the post-intervention group (P < 0.001). The implementation of an apple juice on arrival protocol appeared to be an effective method to reduce clear fluid fasting times in children in our institution.
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Affiliation(s)
- Ashley R Webb
- Department of Anaesthesia, Peninsula Health, Frankston, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ikram Kalam
- Department of Anaesthesia, Peninsula Health, Frankston, Australia
| | - Nicholas Lui
- Department of Anaesthesia, Peninsula Health, Frankston, Australia
| | - Rachael M Loughnan
- Department of Anaesthesia, Peninsula Health, Frankston, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Samuel Leong
- Department of Anaesthesia, Peninsula Health, Frankston, Australia
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Jasarat H, Naumeri F. Comparison of different preoperative fasting times for pediatric elective surgical procedures: A randomized controlled trial. Pak J Med Sci 2024; 40:1321-1325. [PMID: 39092032 PMCID: PMC11255824 DOI: 10.12669/pjms.40.7.8403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/18/2024] [Accepted: 04/12/2024] [Indexed: 08/04/2024] Open
Abstract
Objective To compare the mean residual gastric volume and gastric pH with standard and liberal fasting in children undergoing general anesthesia for elective procedures. Methods A randomized controlled trial (NCT05922072) was conducted at Department of Pediatric Surgery, Mayo Hospital Lahore from June 2021 to December 2021 and 120 patients undergoing elective daycare surgical procedures under general anesthesia were enrolled. Patients were divided into Group-A (Standard fasting) and Group-B (Liberal fasting). Group-A with 6-, 4- and 2-hours Nil per oral (NPO) for solids/ formula milk, breast milk and clear fluid, while Group-B with six, four and one hour NPO for solids/ formula milk, breast milk and clear fluid respectively. Residual gastric volume and pH were measured after anesthetizing the patient. Effect modifiers like age, gender, duration of anesthesia and procedure were controlled through stratification. Post-stratification, t-test was applied and p-value less than 0.05 was taken as statistically significant. Results In Group-A, mean age was 6.1±4.5 years and 6.4±4.6 years in Group-B. Mean residual gastric volume with standard fasting was 0.67±0.48 ml and liberal fasting 0.80±0.44 ml (p value 0.13). Mean gastric fluid pH with standard fasting was 1.72±0.78 as compared to liberal fasting 1.63±0.70 (p value 0.53). Conclusion Free fluid fasting allows for significantly shorter fasting times, though statistically insignificant higher residual gastric volume was recorded in liberal fasting group with a lower pH.
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Affiliation(s)
- Humna Jasarat
- Humna Jasarat, MBBS. Department of Pediatric Surgery, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Fatima Naumeri
- Fatima Naumeri, MBBS, MCPS, FCPS, MCPS-HPE, CME. Department of Pediatric Surgery, Services Institute of Medical Sciences/ Services Hospital, Lahore, Pakistan
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Schmitz A, Kuhn F, Hofmann J, Habre W, Erb T, Preuss M, Wendel-Garcia PD, Weiss M, Schmidt AR. Incidence of adverse respiratory events after adjustment of clear fluid fasting recommendations to 1 h: a prospective, observational, multi-institutional cohort study. Br J Anaesth 2024; 132:66-75. [PMID: 37953199 DOI: 10.1016/j.bja.2023.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/22/2023] [Accepted: 10/07/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Preoperative fasting reduces the risk of pulmonary aspiration during anaesthesia, and 2-h fasting for clear fluids has commonly been recommended. Based on recent evidence of shorter fasting times being safe, the Swiss Society of Paediatric Anaesthesia began recommending 1-h fasting for clear fluids in 2018. This prospective, observational, multi-institutional cohort study aimed to investigate the incidence of adverse respiratory events after implementing the new national recommendation. METHODS Eleven Swiss anaesthesia institutions joined this cohort study and included patients aged 0-15 yr undergoing anaesthesia for elective procedures after implementation of the 1-h fasting instruction. The primary outcome was the perioperative (defined as the time from anaesthesia induction to emergence) incidence of pulmonary aspiration, gastric regurgitation, and vomiting. Data are presented as median (inter-quartile range; minimum-maximum) or count (percentage). RESULTS From June 2019 to July 2021, 22 766 anaesthetics were recorded with pulmonary aspiration occurring in 25 (0.11%), gastric regurgitation in 34 (0.15%), and vomiting in 85 (0.37%) cases. No major morbidity or mortality was associated with pulmonary aspiration. Subgroup analysis by effective fasting times (<2 h [n=7306] vs ≥2 h [n=14 660]) showed no significant difference for pulmonary aspiration between these two groups (9 [0.12%] vs 16 [0.11%], P=0.678). Median effective fasting time for clear fluids was 157 [104-314; 2-2385] min. CONCLUSIONS Implementing a national recommendation of 1-h clear fluid fasting was not associated with a higher incidence of pulmonary aspiration compared with previously reported data.
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Affiliation(s)
- Achim Schmitz
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabian Kuhn
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Hofmann
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Walid Habre
- Unit for Anaesthesiological Investigation, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas Erb
- Department of Anaesthesia, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Preuss
- General Secretary of Association of Swiss Office Based Anaesthesiologists (ASOBA), Joint Office for Outpatient Anesthesia (AGPA) Baden-Dättwil, Switzerland
| | - Pedro D Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Markus Weiss
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander R Schmidt
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University - School of Medicine, Stanford, CA, USA.
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Joshi GP, Abdelmalak BB, Weigel WA, Harbell MW, Kuo CI, Soriano SG, Stricker PA, Tipton T, Grant MD, Marbella AM, Agarkar M, Blanck JF, Domino KB. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting. Anesthesiology 2023; 138:132-151. [PMID: 36629465 DOI: 10.1097/aln.0000000000004381] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
These practice guidelines are a modular update of the "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures." The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.
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Yimer AH, Haddis L, Abrar M, Seid AM. Adherence to pre-operative fasting guidelines and associated factors among pediatric surgical patients in selected public referral hospitals, Addis Ababa, Ethiopia: Cross sectional study. Ann Med Surg (Lond) 2022; 78:103813. [PMID: 35734657 PMCID: PMC9207049 DOI: 10.1016/j.amsu.2022.103813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/14/2022] [Accepted: 05/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background Fasting before anesthesia is mandatory in children to reduce the complications of regurgitation, vomiting, and aspiration during anesthesia and surgery. Prolonged fasting times have several negative implications in children, because high fluid turnover quickly leads to dehydration, hypotension, metabolic disturbances, and hypoglycemia, resulting in poor anesthetic outcomes. Aims This study aimed to assess adherence to preoperative fasting guidelines and associated factors among pediatric patients undergoing elective surgery in Addis Ababa public hospitals in Ethiopia in 2020. Methods A cross-sectional survey was conducted in Addis Ababa, which selected public hospitals in Ethiopia, in 2020. A total of 279 pediatric patients aged <17 years scheduled for elective surgery were included in the study. Data analysis was performed using SPSS V.21, and the values of the variables and factors were checked for associations using logistic regression. Statistical significance was determined at P -value of <0.05. The results are presented in text, tables, charts, and graphs. Results A total of 279 pediatric patients responded to the analysis, with a 98.6% response rate. The majority of the participants (n = 251, 89.96%) did not follow the guidelines for preoperative fasting. The mean fasting time for clear liquids was 10 ± 4.03 (2-18 h) for breast milk 7.18 ± 2.26 (3.5-12 h), and for solid foods 13.5 ± 2.76 (8-19 h). The reasons for which the preoperative fasting delay was due to incorrect order were 35.1%, prior case procedures took longer times 34.1%, and changing sequence of schedule was 20.8%. Conclusion Most children had prolonged fasting. The staff's instructions and schedules were challenged to follow international fasting guidelines.
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Affiliation(s)
- Aragaw Hamza Yimer
- Department of Anesthesia, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Lidya Haddis
- Department of Anesthesia, School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Meron Abrar
- Department of Anesthesia, School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Muhye Seid
- School of Medicine, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
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Wong ANY, Ragg PG, Chong SW, Morton H, Oliver L. Multicenter Survey on Staff Understanding of Preoperative Fasting Guidelines. J Perianesth Nurs 2022; 37:369-373. [PMID: 35177321 DOI: 10.1016/j.jopan.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/05/2021] [Accepted: 05/15/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the knowledge of nursing staff regarding pediatric preoperative fasting in a tertiary pediatric center and a general hospital. DESIGN Anonymous electronic survey with nine questions modified to each institution. METHODS This was a prospective quantitative study. Nursing staff at a tertiary pediatric center and pediatric nursing staff at a general hospital with pediatric services were eligible for participation. An anonymous electronic survey with nine questions via Survey Monkey was used over a 2-month period. FINDINGS There were 295 participants from the tertiary pediatric center and 24 from the general hospital which represented 10% of overall nursing staff at the tertiary pediatric center and approximately 50% of pediatric nursing staff at the general hospital. At both the tertiary pediatric center and the general hospital, 50 to 80% of participants correctly answered most questions. More participants were correct for the fasting times for infants less than 6 month of age than for those over 6 months old. For clear fluids, 61 (20.7%) and 13 (4.4%) considered jelly and breast milk as clear fluids respectively at the tertiary pediatric center. CONCLUSIONS Preoperative fasting continues to be a core area of pediatric care that is not completely understood. Our survey showed that although the majority of staff claim to be able to access the hospital guidelines, knowledge of these guidelines can be improved. In light of ongoing changing evidence, it is clear that education is a key factor in reducing morbidity and improving patient experience related to preoperative fasting.
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Affiliation(s)
- Abigail N Y Wong
- Department of Anaesthesia and Pain Management, Gold Coast University Hospital, Southport, Queensland, Australia.
| | - Philip G Ragg
- Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Simon W Chong
- Department of Anaesthesia, Western Health, Victoria, Australia
| | - Helen Morton
- Pre Admission Resource Centre, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Laura Oliver
- Pre Admission Resource Centre, The Royal Children's Hospital, Parkville, Victoria, Australia
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Paul PA, Joselyn AS, Pande PV, Gowri M. A cross sectional, observational study to evaluate the surgeons' knowledge and perspective on preoperative fasting guidelines in a tertiary care teaching hospital in Southern India. J Anaesthesiol Clin Pharmacol 2022; 38:434-439. [PMID: 36505197 PMCID: PMC9728431 DOI: 10.4103/joacp.joacp_413_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/30/2020] [Accepted: 03/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Aims The preoperative fasting orders given by the Anesthesiologists as per ASA and Enhanced Recovery After Surgery protocol, are often modified by the surgeons, for practical convenience, which can end up with patients being starved for prolonged periods of time. Hence, this study was conducted among various specialty surgical colleagues, to evaluate the knowledge and their perspective regarding patients' preoperative fasting guidelines. Material and Methods A validated questionnaire was distributed to 68 surgeons belonging to various surgical specialties, which included consultants and postgraduate residents. The surgeons were grouped as surgeons operating only on children, only on adults, and on adults and children (mixed). Data were summarized using the mean (SD)/median for continuous variables and categorical data were expressed as frequency and percentage. The difference in knowledge score, among the surgeons of three groups, was analyzed using ANOVA, with Bonferroni as post hoc. Results This study shows an overall decrease in knowledge (score of 6.13 ± 1.74) about preoperative fasting guidelines among surgeons. We found that the level of knowledge about preoperative fasting guidelines and complications was higher among surgeons who operate only on children (score of 7.05) as compared to surgeons operating only on adults (score 5.5) and adults and children (mixed) (score 6.1), which was statistically significant (P = 0.013). We found no difference in knowledge level based on designation and gender. All the surgeons uniformly had the perspective that patients have to be kept fasting preoperatively. Conclusion Preoperative fasting orders for all surgical patients, especially for vulnerable patients such as children and geriatrics, should be administered by the anesthesiologist or surgeon who is familiar with fasting guidelines. We intend to raise the awareness of fasting guidelines of surgical colleagues by putting up placards and posters in the wards.
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Affiliation(s)
| | - Anita Shirley Joselyn
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India,Address for Correspondence: Dr. Anita Shirley Joselyn, Department of Anaesthesia, Christian Medical College & Hospital, Vellore - 632 002, Tamil Nadu, India. E-mail:
| | - Priyanka Vandana Pande
- Department of Pediatric Emergency, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Puri K, Kundal R, Kundal V, Pawar JG, Kumar A, Choudhury SR. Influence of Parental Awareness Drive on Preoperative Fasting Compliance in Pediatric Day Care Surgery. J Indian Assoc Pediatr Surg 2022; 27:236-240. [PMID: 35937103 PMCID: PMC9350648 DOI: 10.4103/jiaps.jiaps_390_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/16/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022] Open
Abstract
CONTEXT Optimum preoperative fasting is imperative for the prevention of aspiration in pediatric patients. The current guidelines advocate 2-4-6 rule for the same. However, direct supervision is lacking in large volume centers. AIMS Thus, we aimed to determine the fasting compliance of children preoperatively and to ascertain whether parents understood the significance and purpose of optimum fasting. MATERIALS AND METHODS Design - A prospective questionnaire-based study regarding preoperative fasting was performed in pediatric patients aged 1-10 years scheduled for "day care surgery" or "same day admission surgery" over 12 weeks. Thereafter, parental awareness drive was carried out, and a re-audit was performed with a questionnaire in the next cohort of patients. RESULTS The number of patients in the pre and postcounseling groups were 98 and 99. Thirteen percent of the patients were optimally fasted for solids initially. Re-audit confirmed compliance increased to 46%. Patients fasting adequately (2-3 h) for clear fluids increased from 22.4% to 51.5% postcounseling. The number for optimally breast-fed children increased postaudit (23.1%-39.1%). Consequent to the drive, parental awareness increased and 49.5% parents knew that only plain water was permitted during fasting. Number of parents considering preoperative fasting important increased from 39.8% to 79.7%. Initially, 27.6% of the parents did not know the reason for fasting, which reduced to 3% postaudit. CONCLUSION Parents are misinformed and ignorant about optimum preoperative fasting. Adequate education and awareness to improve their knowledge was associated with increased compliance for optimal fasting.
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Affiliation(s)
- Kriti Puri
- Department of Anesthesiology, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Raksha Kundal
- Department of Anesthesiology, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India,Address for correspondence: Dr. Raksha Kundal, Department of Anesthesiology, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India. E-mail:
| | - Vijay Kundal
- Department of Pediatric Surgery ABVIMS, Dr RML Hospital, New Delhi, India
| | | | - Ajai Kumar
- Department of Anesthesiology, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Subhasis Roy Choudhury
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
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Schmidt AR, Fehr J, Man J, D'Souza G, Wang E, Claure R, Mendoza J. Pre-operative fasting times for clear liquids at a tertiary children's hospital; what can be improved? Anesth Pain Med (Seoul) 2021; 16:266-272. [PMID: 34289299 PMCID: PMC8342827 DOI: 10.17085/apm.21025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/10/2021] [Indexed: 12/28/2022] Open
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 operating room [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 In total 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.
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Affiliation(s)
- Alexander R Schmidt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - James Fehr
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Janice Man
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Genevieve D'Souza
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ellen Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Rebecca Claure
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Julianne Mendoza
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Assen HE, Hassen AM, Abate A, Liyew B. Preoperative Fasting Time and Its Association with Hypoglycemia during Anesthesia in Pediatric Patients Undergoing Elective Procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9166603. [PMID: 34337059 PMCID: PMC8298163 DOI: 10.1155/2021/9166603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preoperative fasting is important to reduce the risk of pulmonary aspiration during anesthesia. The influence of prolonged fasting time on glucose levels during anesthesia in children remains uncertain. Therefore, this study is aimed at assessing preoperative fasting time and its association with hypoglycemia during anesthesia in pediatric patients undergoing elective procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. The research hypothesis of the study is as follows: there is a prolonged preoperative fasting time, and it influences the glucose levels during anesthesia among pediatric patients undergoing elective procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. METHODS Institutional based cross-sectional study was conducted among 258 pediatric patients who had undergone elective procedures in a tertiary care center. A systematic sampling method was used to select study participants. The data were collected through face-to-face interviews and medical record reviews. Binary logistic regression was used to identify associated factors of hypoglycemia during anesthesia among pediatric patients undergoing elective procedures. All explanatory variables with a p value of ≤0.25 from the bivariable logistic regression model were fitted into the multivariable logistic regression model to control the possible effect of confounders, and finally, the variables which had an independent association with hypoglycemia were identified based on adjusted odds ratio with 95% confidence interval, and a p value less than 0.05 was significant. RESULTS The mean (standard deviation) fasting hours from breast milk, solid foods, and clear fluids were 7.75 (2.89), 13.25 (3.14), and 12.31 (3.22), respectively. The majority (89.9%, 57.9%, and 100%) of participants had fasted from solid, breast milk, and clear fluids for more than 8, 6, and 4 hours, respectively. More than one-fourth (26.2%) of participants were hypoglycemic immediately after induction. Residence, order of nothing per mouth, source of patient, and duration of fasting from solid foods had a significant association with hypoglycemia during anesthesia in children. CONCLUSION Children undergoing elective procedures were exposed to unnecessarily long fasting times which were associated with hypoglycemia during anesthesia.
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Affiliation(s)
- Hussien Endris Assen
- Department of Anesthesia, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Anissa Mohammed Hassen
- School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Ananya Abate
- Department of Anesthesiology, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bikis Liyew
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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13
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Thomasseau A, Rebollar Y, Dupuis M, Marschal N, Mcheik J, Debaene B, Frasca D, Boisson M. Observance of preoperative clear fluid fasting in pediatric anesthesia: oral and written information versus text message information. A before-and-after study. Paediatr Anaesth 2021; 31:557-562. [PMID: 33523536 DOI: 10.1111/pan.14145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Prolonged fasting before surgery is common in pediatrics. In the literature, it is responsible for hypotension, irritability and postoperative nausea and vomiting. Despite clear instructions given during the preanesthetic consultation, fasting rules are respected in only 30%-40% of cases. We aimed to evaluate the benefit of sending a text message the day before surgery to improve the parents' observance of fasting rules. METHODS We conducted a before-and-after study at the University Hospital of Poitiers. From August to October 2018, 172 parents of children under 15 years of age scheduled for all types of surgery were enrolled into two groups according to the period: the control group with parents receiving information on preoperative fasting rules during the preanesthetic consultation several days before surgery, and the text message group, receiving the same information during consultation plus a text message the day before the surgery. RESULTS There was a difference in observance of clear fluid fasting instructions (between 2 and 3 h before the admission at hospital) in favor of the text message group 33% versus 92% OR 29.2 (10.9-95.2) p < 0.001, and in average fasting time for clear fluids 8.7 h ± 4.8 h vs. 4.3 h ± 2.4 h (p < 0.001). CONCLUSION Sending of a reminder text message to the parents the day before the surgery resulted in a significant increase in observance of fasting rules in children undergoing scheduled surgery.
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Affiliation(s)
- Alexandre Thomasseau
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France
| | - Yohann Rebollar
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France
| | - Maxime Dupuis
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France
| | - Nathalie Marschal
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France
| | - Jiad Mcheik
- Service médico-chirurgical de pédiatrie, CHU de Poitiers, Poitiers cedex, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Bertrand Debaene
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Denis Frasca
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Matthieu Boisson
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
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14
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Zhu Q, Li Y, Deng Y, Chen J, Zhao S, Bao K, Lai L. Preoperative Fasting Guidelines: Where Are We Now? Findings From Current Practices in a Tertiary Hospital. J Perianesth Nurs 2021; 36:388-392. [PMID: 33678495 DOI: 10.1016/j.jopan.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE New evidence-based fasting guidelines have been published in recent years. However, while water and solid food fasting times before anesthesia are recommended to be 2 and 6 hours, respectively, these times are often longer in clinical practice. This study aimed to investigate the awareness and implementation of the fasting guideline recommendations among nurses and anesthesiologists, as well as evaluate the actual fasting durations in patients in a tertiary hospital. DESIGN A cross-sectional study was used. METHODS Questionnaires were designed to collect the knowledge of fasting time among registered anesthesiologists and nurses. Data on the instructed and actual fasting durations among patients scheduled for elective surgery were evaluated. FINDINGS Approximately half of the nurses indicated that solid food fasting durations were shorter than 6 hours or longer than 8 hours, and two-thirds indicated that clear fluid fasting durations were shorter than 2 hours or longer than 4 hours. However, in clinical practice, nurse-instructed fasting durations were longer than what they knew was optimal. The anesthesiologists also prescribed longer fasting durations than the minimum fasting duration recommended. The actual fasting durations of the patients were significantly longer than the nurse-instructed fasting durations for solid food (13.41 ± 2.64 vs 9.87 ± 2.20 hours, P < .001) and clear fluids (10.27 ± 3.67 vs 8.98 ± 2.90 hours, P < .001). The nurse-instructed durations were significantly longer than the anesthesiologist-instructed durations according to the statements of patients (9.87 ± 2.20 vs 9.00 ± 2.00 hours for solid food, P < .001; 8.98 ± 2.90 vs 6.15 ± 3.25 hours for clear fluids, P < .001). CONCLUSIONS Excessive fasting durations were observed among patients. Anesthesiologists and nurses must work together to ensure that updated fasting instructions are implemented in routine clinical practice.
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Affiliation(s)
- Qianqian Zhu
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China.
| | - Yamei Li
- Department of Urology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
| | - Yingqing Deng
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
| | - Jiaxin Chen
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
| | - Shuhua Zhao
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
| | - Kaibei Bao
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
| | - Lifei Lai
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
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15
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Effects of a short message service (SMS) by cellular phone to improve compliance with fasting guidelines in patients undergoing elective surgery: a retrospective observational study. BMC Health Serv Res 2021; 21:27. [PMID: 33407397 PMCID: PMC7788820 DOI: 10.1186/s12913-020-06039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Contemporary perioperative fasting guidelines aim to alleviate patient discomfort before surgery and enhance postoperative recovery whilst seeking to reduce the risk of pulmonary aspiration during anesthesia. The impact of a short message service (SMS) reminder on fasting guideline compliance is unknown. Therefore, we performed a retrospective observational study and quality improvement project aiming to quantify the extent of excessive and prolonged fasting, and then assessed the impact of a SMS reminder in reducing fasting times. Methods After ethics committee approval we performed a retrospective observational study investigating preoperative fasting times of adult patients undergoing elective surgery. First, we assessed whether the fasting guideline times were adhered to (Standard Care group). All patients received internationally recommended fasting guidelines in the form of a written hospital policy document. We then implemented an additional prompt via a mobile phone SMS 1 day prior to surgery containing a reminder of fasting guideline times (SMS group). The primary aims were to compare fasting times between the Standard Care group and the SMS group. Results The fasting times of 160 patients in the Standard Care group and 110 patients in the SMS group were evaluated. Adherence to the fasting guidelines for solids occurred in 14 patients (8.8%) in the Standard Care group vs. Twenty-two patients (13.6%) in the SMS group (p=0.01). Adherence to the fasting guidelines for fluids occurred in 4 patients (2.5%) in the Standard Care group vs. Ten patients (6.3%) in the SMS group (p=0.023). Patients in the Standard Care group had a longer median (inter-quartile range (IQR)) fasting time for fluids compared the SMS group [6.5 h (IQR 4.5:11) vs 3.5 h (IQR 3:8.5), p< 0.0001]. Median fasting times for solids were 11 h (IQR 7:14) in the Standard Care group and 11.5 h (IQR 7:13.5) in the SMS group (p=0.756). Conclusion Adherence to internationally recommended fasting guidelines for patients undergoing elective surgery is poor. The introduction of a fasting guideline reminder via a mobile phone SMS in addition to a written hospital policy improved adherence to fasting advice and reduced the fasting times for fluids but not for solids. The use of an SMS reminder of fasting guidelines is a simple, feasible, low-cost, and effective tool in minimising excessive fasting for fluids among elective surgical patients. Trial registration ACTRN12619001232123 (Australia New Zealand Clinical Trials Registry). Registered 6th September 2019 (retrospectively registered).
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16
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Huang X, Zhang H, Lin Y, Chen L, Peng Y, Jiang F, Lin F, Li S, Lin L. Effect of Oral Glucose Water Administration 1 Hour Preoperatively in Children with Cyanotic Congenital Heart Disease: A Randomized Controlled Trial. Med Sci Monit 2020; 26:e922642. [PMID: 32621736 PMCID: PMC7357253 DOI: 10.12659/msm.922642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Guidelines recommend a clear liquid fasting time of 2 h before surgery, which is often exceeded, leading to adverse reactions (ARs) such as discomfort, thirst, and dehydration. We assessed the gastric contents and ARs after oral glucose water administration 1 h prior to surgery in children with cyanotic congenital heart disease (CCHD). Material/Methods This was a non-inferiority randomized controlled trial of children with CCHD enrolled at the Fujian Medical University Union Hospital from 09/2014 to 05/2017 and randomized to receive oral glucose water (10 g of glucose in 100 ml of warm water, 5 ml/kg) 2 h (2-h group, n=174) or 1 h (1-h group, n=170) before surgery. The primary endpoint was gastric volume. Secondary endpoints included pH of gastric content, preoperative blood glucose, and risk factors for aspiration pneumonia. Pre- and intraoperative ARs were recorded. Results The 1-h group showed smaller gastric content volumes (0.34±0.35 (95% CI: 0.29–0.39) vs. 0.43±0.33 (95% CI: 0.38–0.48) ml/kg, t=2.55, P<0.05) and higher blood glucose (6.21±0.78 (95% CI: 6.09–6.33) vs. 5.59±1.11 (95% CI: 5.43–5.76) mmol/L, t=−5.91, P<0.001). The 95% confidence interval of the volume difference between the 2 groups was 0.017–0.163, the upper limit value was 0.163 <δ=0.2 (P<0.01). The non-inferiority hypothesis was correct. The 1-h group showed lower incidence of crying, thirst and hypoxia (all P<0.05 vs. 2-h group). There were no differences in ARs between the 2 groups. Conclusions A 1-h fast prior to surgery was not inferior to a 2-h fast in terms of gastric residuals and ARs in pediatric patients with CCHD. Clinical trial registration: http://www.chictr.org.cn/showprojen.aspx?proj=9563 Registration number: ChiCTR-IPR-14005270
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Affiliation(s)
- Xizhen Huang
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Haoruo Zhang
- Fujian Medical University Union Clinical Medicine College, Fuzhou, Fujian, China (mainland)
| | - Yanjuan Lin
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Liangwan Chen
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Yanchun Peng
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Fei Jiang
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Fen Lin
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Sailan Li
- Heart Medicine Research Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, China (mainland)
| | - Lingyu Lin
- Department of Nursing, Fujian Medical University, Fuzhou, Fujian, China (mainland)
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17
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Dongare PA, Bhaskar SB, Harsoor SS, Garg R, Kannan S, Goneppanavar U, Ali Z, Gopinath R, Sood J, Mani K, Bhatia P, Rohatgi P, Das R, Ghosh S, Mahankali SS, Singh Bajwa SJ, Gupta S, Pandya ST, Keshavan VH, Joshi M, Malhotra N. Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists. Indian J Anaesth 2020; 64:556-584. [PMID: 32792733 PMCID: PMC7413358 DOI: 10.4103/ija.ija_735_20] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Pradeep A Dongare
- Assistant Professor, Department of Anaesthesiology, ESIPGIMSR, Bengaluru, India
| | - S Bala Bhaskar
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari, India
| | - S S Harsoor
- Professor, Department of Anaesthesiology, Dr BR Ambedkar Medical College and Hospital, Bengaluru, India
| | - Rakesh Garg
- Additional Professor, Department of Onco-Anaesthesia, Pain and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
| | - Sudheesh Kannan
- Professor, Department of Anaesthesiology, BMCRI, Bengaluru, India
| | - Umesh Goneppanavar
- Professor, Department of Anaesthesiology, Dharwad Institute of Mental Health and Neurosciences, Dharwad, India
| | - Zulfiqar Ali
- Associate Professor, Department of Anesthesiology and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ramachandran Gopinath
- Professor and Head,Department of Anaesthesiology and Intensive Care, ESIC Medical College and Hospital, Hyderabad, India
| | - Jayashree Sood
- Honorary. Joint Secretary, Board of Management, Chairperson, Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Kalaivani Mani
- Scientist IV, Department of Biostatistics, AIIMS, New Delhi, India
| | - Pradeep Bhatia
- Professor and Head, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Rekha Das
- Professor and Head, Department Anaesthesiology, Critical care and Pain, Acharya Harihar Post Graduate Institute of Cancer, Cuttack, India
| | - Santu Ghosh
- Assistant Professor, Department of Biostatistics, St John's Medical College, Bengaluru, India
| | | | - Sukhminder Jit Singh Bajwa
- Professor and Head, Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Punjab, India
| | - Sunanda Gupta
- Professor and Head, Department of Anaesthesiology, Geetanjali Medical College and Hospital, Udaipur, India
| | - Sunil T Pandya
- Chief of Anaesthesia and Surgical ICU, AIG Hospitals, Hyderabad, India
| | - Venkatesh H Keshavan
- Senior Consultant and Chief, Department of Neuroanaesthesia and Critical Care, Apollo Hospitals, Bengaluru, India
| | - Muralidhar Joshi
- Head, Department of Anaesthesia and Pain Medicine, Virinchi Hospitals, Hyderabad, India
| | - Naveen Malhotra
- Professor, Department of Anaesthesiology and In Charge Pain Management Centre, Pt BDS PGIMS, Haryana, India
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18
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Zhang G, Huang X, Shui Y, Luo C, Zhang L. Ultrasound to guide the individual medical decision by evaluating the gastric contents and risk of aspiration: A literature review. Asian J Surg 2020; 43:1142-1148. [PMID: 32171605 DOI: 10.1016/j.asjsur.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/16/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022] Open
Abstract
Pulmonary aspiration of gastric contents is one of the most terrible complications following general anesthesia. It is important for patients to prevent this complication by obeying the preoperative fasting protocol strictly. At present, it has been reported by many studies that bedside ultrasound, as a non-invasive and convenient method, could be used to evaluate gastric contents qualitatively and quantitatively. With the advantages of reliability, accuracy and repeatability, it can greatly reduce the risk of aspiration and ensure patients' life security. But most of the data were acquired from the healthy volunteers. For the gastrointestinal disorder, the pregnant women, obesity, children, the elderly and diabetes patients, the accuracy and reliability of ultrasound to predict the risk of aspiration remains to be identified by more further studies. For these patients with increasing risk of aspiration, I-AIM (Indication, Acquisition, Interpretation, Medical decision-making) framework plays an important role in ensuring the safety of patients. It is crucial to make appropriate clinical decisions by evaluating the gastric contents with ultrasound.
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Affiliation(s)
- Gang Zhang
- Department of Anesthesia, Sichuan Provincial Orthopedic Hospital (Chengdu Sports Hospital and Chengdu Research Institute for Sports Injury), Chengdu, 610041, China
| | - Xiaoyan Huang
- Operation Room, The Third People's Hospital of Chengdu, Chengdu, 610031, China
| | - Yunhua Shui
- Department of Anesthesia, Sichuan Provincial Orthopedic Hospital (Chengdu Sports Hospital and Chengdu Research Institute for Sports Injury), Chengdu, 610041, China
| | - Chunqiong Luo
- Department of Anesthesia, Sichuan Provincial Orthopedic Hospital (Chengdu Sports Hospital and Chengdu Research Institute for Sports Injury), Chengdu, 610041, China
| | - Lan Zhang
- Department of Anesthesia, Sichuan Provincial Orthopedic Hospital (Chengdu Sports Hospital and Chengdu Research Institute for Sports Injury), Chengdu, 610041, China.
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19
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Singla K, Bala I, Jain D, Bharti N, Samujh R. Parents' perception and factors affecting compliance with preoperative fasting instructions in children undergoing day care surgery: A prospective observational study. Indian J Anaesth 2020; 64:210-215. [PMID: 32346168 PMCID: PMC7179783 DOI: 10.4103/ija.ija_794_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/03/2019] [Accepted: 01/29/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Fasting guidelines have been recommended in the paediatric population to minimise the risk of pulmonary aspiration. The present study was planned to assess the compliance with fasting instructions in children undergoing ambulatory surgery and identify the factors affecting it. Methods: A total of 1,050 ASA I and II children aged 1–12 years, scheduled for day care surgery were enrolled. Parents of these children were given a questionnaire with specific questions like fasting instructions, source of instructions, actual fasting times and reasons for not following instructions. Results: Only 90 (8.5%) parents followed fasting instructions as advised. Of the 960 non-compliant patients, 31 (2.9) inadequately fasted while 929 (88.4%) fasted more than advised. While only 5.2% mentioned aspiration, 25% cited vomiting as the reason for fasting. Younger parents (OR = 0.853, 95% CI-0.796 to 0.915), fasting instructions in writing (OR = 10.808, 95% CI-1.459 to 80.059) and separate instruction for solids and liquids (OR = 6.016, 95% CI- 3.663 to 9.883) were found to affect compliance with fasting instructions. Conclusion: To avoid risks of prolonged or inadequate fasting in day care surgical patients, good coordination between the anaesthetist and the surgeon and an updated knowledge about the preoperative fasting instructions among the health-care providers is essential. Separate written fasting instructions for liquids and solids should be given to the parents according to their order in the operating list to ensure better compliance with fasting instructions.
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Affiliation(s)
- Karan Singla
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Bala
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Jain
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bharti
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Elliott EM, Isserman RS, Stricker P, Yaddanapudi S, Subramanyam R. Fasting for anaesthesia: Less is more! Indian J Anaesth 2020; 64:87-89. [PMID: 32139924 PMCID: PMC7017675 DOI: 10.4103/ija.ija_936_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Elizabeth M Elliott
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, USA. E-mail:
| | - Rebecca S Isserman
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, USA. E-mail:
| | - Paul Stricker
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, USA. E-mail:
| | - Sandhya Yaddanapudi
- Department of Anesthesia and Critical Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Subramanyam
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, USA. E-mail:
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21
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Al-Robeye AM, Barnard AN, Bew S. Thirsty work: Exploring children's experiences of preoperative fasting. Paediatr Anaesth 2020; 30:43-49. [PMID: 31665824 DOI: 10.1111/pan.13759] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/19/2019] [Accepted: 10/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative fasting is performed to reduce aspiration risk during general anesthesia. Recommendations are that patients should fast for 6 hours from solids and nonhuman milk, 4 hours from breast milk, and 2 hours from clear fluids. However, previous studies have shown that children fast far in excess of these times, which can result in perioperative complications and unnecessary discomfort for the child. AIMS This prospective, mixed-methods study aims to explore the experiences of pediatric patients undergoing preoperative fasting in Leeds General Infirmary. It also aims to investigate fasting durations of these patients and factors which influence these. METHODS Over 2 weeks, surveys were distributed to all parents of elective pediatric patients and completed prior to their child being called to theater. Children over the age of six were offered a child survey, which had been specifically developed for the study, with visual Likert scales and an area for free text. The gathering of children's comments about their experience of preoperative fasting is unique to this study. RESULTS Seventy-one parent surveys and 48 child surveys were completed, with a mean patient age of 8.3 years (SD 4.1). The mean preoperative fasting time for food was 11.7 hours (SD 4.4) and 6.9 hours (SD 5.0) for fluids. Fasting times were far in excess of the minimums recommended, negatively impacting patient experience with 34% reporting being hungry/very hungry and 19% thirsty/very thirsty. Most children's comments suggested that they coped well with the fasting; however, several children reported feelings of sadness and anxiety. CONCLUSION Preoperative fasting times in pediatric patients far exceed the durations set by international guidelines. Given that many children reported extreme feelings of hunger and thirst or emotional effects from the fast, these durations need to be optimized in order to improve patient experience.
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Affiliation(s)
- Arwa Mohammed Al-Robeye
- Department of Pediatric Anaesthesia, Leeds General Infirmary, Leeds, UK.,Leeds Medical School, University of Leeds, Leeds, UK
| | - Anna Nicole Barnard
- Department of Pediatric Anaesthesia, Leeds General Infirmary, Leeds, UK.,Leeds Medical School, University of Leeds, Leeds, UK
| | - Stephanie Bew
- Department of Pediatric Anaesthesia, Leeds General Infirmary, Leeds, UK
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22
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Hajian P, Shabani M, Khanlarzadeh E, Nikooseresht M. The Impact of Preoperative Fasting Duration on Blood Glucose and Hemodynamics in Children. J Diabetes Res 2020; 2020:6725152. [PMID: 32904566 PMCID: PMC7456475 DOI: 10.1155/2020/6725152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/14/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Prolonged preoperative fasting is one of the concerns of pediatricians and anesthesiologists in pediatric surgery. The aim of this study was to assess the impact of preoperative fasting duration on blood glucose and hemodynamics in children. METHODS This cross-sectional study was conducted on 50 children who were between the ages of 3 and 12 years in Besat Hospital, Hamedan, Iran. The time of the last solid and liquid meal taken by child were recorded based on interview with the parents. The first blood glucose test was obtained in the operation room, and the second test was performed 20 minutes after induction of anesthesia by glucometer. Systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR) were recorded before anesthesia induction and in five-minute intervals in the first 20 minutes of surgery. RESULTS The mean age of the children was 6.63 (SD 1.85) years. Mean blood glucose 20 minutes after surgery was 101.17 (SD 92) mg/dl, which was significantly higher than the baseline values (87.66 (SD 11.84) mg/dl) (P < 0.001). The comparison of mean blood glucose level between groups of fasting with different duration for solids (<12 hours and >12 hours) and for liquids (<6 hours and >6 hours) revealed no significant difference in either groups (P > 0.05). No significant correlation was observed between blood glucose level at the induction of anesthesia with weight and age (P > 0.05). There was a significantly negative correlation between duration of fasting for liquids and SBP (P > 0.05). CONCLUSION Prolonged preoperative fasting cannot affect blood glucose in children; however, maybe it has impact on systolic blood pressure.
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Affiliation(s)
- Pouran Hajian
- Department of Anesthesiology, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Minoo Shabani
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Elham Khanlarzadeh
- Department of Community Medicine, School of Medicine Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahshid Nikooseresht
- Department of Anesthesiology, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
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Panjiar P, Kochhar A, Vajifdar H, Bhat K. A prospective survey on knowledge, attitude and current practices of pre-operative fasting amongst anaesthesiologists: A nationwide survey. Indian J Anaesth 2019; 63:350-355. [PMID: 31142877 PMCID: PMC6530283 DOI: 10.4103/ija.ija_50_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: Pre-operative fasting is a routine practice to minimise the risk of pulmonary aspiration. The leading societies of anaesthesia have adopted more liberal fasting guidelines to avoid the adverse effect of prolonged fasting. This survey was conducted to assess the knowledge, attitude and current practice of fasting guidelines among Indian anaesthesiologists and to analyse the reasons for non-compliance of these guidelines. Methods: A questionnaire consisted of 11 questions was distributed via 'Survey Monkey' software to 621 anaesthesiologists who attended the annual conference of the Indian Society of Anaesthesiologists held in Ludhiana, in 2016. American Society of Anaesthesiologists (ASA) practice guidelines for fasting were the standard of assessment. Results: The response rate to the survey was 52%. Of the respondents, 69% described correctly the practice guidelines to pre-operative fasting. Only seven percent respondents were aware of the benefits of liberalised fasting. More than 2/3rd of the respondents advised fasting as per ASA guidelines during pre-anaesthetic check-up (PAC). However, only about 50% respondents confirmed that these guidelines are actually followed in their institution. Not having control on scheduling of cases in operation theatre and poor knowledge of ward nurses and surgeons were the common reasons for non-compliance of these guidelines. Twenty four percent respondents did not use routinely any drug for aspiration prophylaxis. Conclusion: Majority of the respondents were aware of the ASA fasting guidelines. However, the implementation of the guidelines and knowledge regarding benefits of liberalised fasting is poor among respondents.
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Affiliation(s)
- Pratibha Panjiar
- Department of Anaesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Anjali Kochhar
- Department of Anaesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Homay Vajifdar
- Department of Anaesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Kharat Bhat
- Department of Anaesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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Schmidt A, Buehler K, Both C, Wiener R, Klaghofer R, Hersberger M, Weiss M, Schmitz A. Liberal fluid fasting: impact on gastric pH and residual volume in healthy children undergoing general anaesthesia for elective surgery. Br J Anaesth 2018; 121:647-655. [DOI: 10.1016/j.bja.2018.02.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 12/31/2022] Open
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Preoperative Fasting Guidelines in Children: Should They Be Revised? Case Rep Anesthesiol 2018; 2018:8278603. [PMID: 30225146 PMCID: PMC6129370 DOI: 10.1155/2018/8278603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/04/2018] [Accepted: 07/15/2018] [Indexed: 11/17/2022] Open
Abstract
Children presenting with ingestion of foreign bodies need gastroscopy as a primary management modality. A controversy lies regarding guidelines for preoperative fasting among children with low risk of aspiration and intraoperative complications. This case report represents cases of children who ingested foreign bodies and underwent fasting at different times preoperatively. With mounting evidence questioning the benefits of long durations of fasting in decreasing the risk of aspiration and with studies showing that fasting for more than 2 hours after ingestion of clear fluid does not significantly alter gastric pH or volume, these incidental findings raise the question of whether it is safe to keep children NPO, for a shorter duration before the administration of anesthesia. In addition, this report shows that current guidelines are in need of revision.
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Jayasinghe V, Mahesh PB, Sooriaarachchi C, Jayalath J, Karunarathne W, Liyanage SN. Evaluation of the effect of pre-operative over-fasting on post-operative vomiting in children undergoing bone marrow aspiration at a tertiary care setting in Sri Lanka: A prospective cohort study. Indian J Anaesth 2018; 62:366-370. [PMID: 29910494 PMCID: PMC5971625 DOI: 10.4103/ija.ija_727_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background and Aims Non-adherence to standard fasting guidelines may result in perioperative complications. We aimed to determine the association between pre-operative over-fasting and post-operative vomiting amongst children undergoing bone marrow aspiration under general anaesthesia. Methods A prospective cohort study was conducted from May 2015 to April 2016 in children undergoing bone marrow aspiration under general anaesthesia and their caregivers. Children fasted for ≥3 hours from last clear fluid intake constituted the exposed group (n = 202) while children fasting for <3 h constituted the non-exposed group (n = 202). The primary outcome was the development of post-operative vomiting during the 6 h following induction of anaesthesia. The awareness of the caregiver regarding the importance of keeping the child fasting before anaesthesia was evaluated. Results The mean (standard deviation) duration time of fasting of the exposed and non-exposed groups were 7.2 (2.4) and 2.2 (0.3) h, respectively. Thirty-two (15.8%) children in the exposed group and 17 (8.4%) children in the non-exposed group developed post-operative vomiting. The relative risk of developing post-operative vomiting amongst over-fasting children was 1.9 (95% confidence interval [CI] = 1.1-3.3, P = 0.02), while adjusting to the age, it was 2.1 (95% CI = 1.1-4). Significantly more caregivers were clear about the fasting advice in the non-exposed group than in the exposed group (P < 0.001). Conclusion Over-fasting is a significant risk factor to develop post-operative vomiting in paediatric anaesthetic practice.
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Affiliation(s)
- Vidura Jayasinghe
- Department of Community Medicine, Post-Graduate Institution of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Pk Buddhika Mahesh
- Department of Medical Administration, Regional Director office of Colombo, Colombo, Sri Lanka
| | - Cmd Sooriaarachchi
- Department of Anaesthesia, National Cancer Institute Maharagama, Maharagama, Sri Lanka
| | - Jimutha Jayalath
- Department of Anaesthesia, National Cancer Institute Maharagama, Maharagama, Sri Lanka
| | - Weranga Karunarathne
- Department of Anaesthesia, National Cancer Institute Maharagama, Maharagama, Sri Lanka
| | - S N Liyanage
- Department of Community Medicine, Post-Graduate Institution of Medicine, University of Colombo, Colombo, Sri Lanka
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Andersson H, Hellström PM, Frykholm P. Introducing the 6-4-0 fasting regimen and the incidence of prolonged preoperative fasting in children. Paediatr Anaesth 2018; 28:46-52. [PMID: 29168341 DOI: 10.1111/pan.13282] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Children often starve for longer than recommended by current preoperative fasting guidelines. AIMS We studied the effects of implementing a more lenient fasting regimen on the duration of clear fluid fasting, as well as the incidence of extended fasting in children. METHODS Preoperative duration of clear fluid fasting was recorded for patients scheduled for procedures in a unit applying the standard 6-4-2 fasting regimen. This group was compared with a cohort in the same unit 1 year after transitioning to a 6-4-0 fasting regimen. The latter includes no limitations on clear fluid intake until the child is called to theater. A third cohort from a unit in which the 6-4-0 fasting regimen has been implemented for over a decade was also studied for comparison. RESULTS Patients fasting according to the 6-4-2 fasting regimen (n = 66) had a median fasting time for clear fluids of 4.0 h and a 33.3% incidence of fasting more than 6 h. After transitioning to the 6-4-0 fasting regimen (n = 64), median duration of fasting for clear fluids decreased to 1.0 h, and the incidence of fasting more than 6 h decreased to 6.3%. In the second unit (n = 73), median fasting time was 2.2 h and the proportion of patients fasting more than 6 h was 21.9%. CONCLUSION The introduction and implementation of the 6-4-0 fasting regimen reduces median fluid fasting duration and the number of children subjected to extended fasting.
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Affiliation(s)
- Hanna Andersson
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Per M Hellström
- Department of Medical Sciences, Gastroenterology, Uppsala University Hospital, Uppsala, Sweden
| | - Peter Frykholm
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
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Preoperative Fasting among Adult Patients for Elective Surgery in a Kenyan Referral Hospital. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2017; 2017:2159606. [PMID: 28487877 PMCID: PMC5405382 DOI: 10.1155/2017/2159606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/24/2017] [Accepted: 04/02/2017] [Indexed: 12/13/2022]
Abstract
Background. Preoperative fasting (POF) is physiologically and precautionary important during anesthesia and surgery. POF from midnight has been practiced despite the recommended shorter practice. Objective. Assessing preoperative fasting among adult patients scheduled for elective surgery at Kenyatta National Hospital (KNH). Methods. A descriptive cross-sectional study involving 65 surgical patients. A questionnaire of mixed questions on demographics, reasons, source of instructions, opinion on instructions, time, premedication practices, outcome, and complains on NPO was used. Analysis was quantitatively done with SPSS v. 22. Ethical approval was obtained from KNH-UoN ERC. Results. Of the respondents 93.8% lacked knowledge on the correct reasons for POF and felt that the instructions were unclear and less important <50%. POF instructions were administered by nurses 80%, anesthetists 15%, and surgeons 5%. Most of respondents (73.8%) fasted > 15 hours. The POF outcomes were rated moderately challenging as follows: prolonged wait for surgery 44.6%, thirst 43.1%, hunger 36.9%, and anxiety 29.2%. Conclusion. Nurses are critical in providing POF instructions and care, and patient knowledge level is a mirror reflection of the quality of interventions. This underscores the need to build capacity for nurses and strengthen the health system to offer individualized preoperative interventions as well as monitoring and clinical auditing of fasting practices.
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Greenstein AM, Morton N, Patil V. Comment on 'Optimized preoperative fasting times decrease ketone body concentration and stabilize mean arterial blood pressure during induction of anesthesia in children younger than 36 months: a prospective observational cohort study'. Paediatr Anaesth 2017; 27:106-107. [PMID: 28004500 DOI: 10.1111/pan.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Neil Morton
- Department of Anaesthesia, Barts and The London School of Medicine, London, UK
| | - Vinodkumar Patil
- Department of Anaesthesia, Queens Hospital, BHR NHS Trust, Romford, UK
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Brunet-Wood K, Simons M, Evasiuk A, Mazurak V, Dicken B, Ridley D, Larsen B. Surgical fasting guidelines in children: Are we putting them into practice? J Pediatr Surg 2016; 51:1298-302. [PMID: 27166876 DOI: 10.1016/j.jpedsurg.2016.04.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/07/2016] [Accepted: 04/11/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients are traditionally kept fasting (NPO) from midnight prior to surgery, to prevent aspiration during anesthesia. NPO time is continued postoperatively, out of concern for ileus. Prolonged periods of NPO place the pediatric population at risk for under-nutrition. Published guidelines for preoperative NPO times have been shown to be safe. The aim of this study was to investigate current pre- and postoperative feeding practices of children at a pediatric tertiary care hospital. METHODS Medical charts were used to extract data prospectively from 53 patients undergoing general, neurosurgical, or urological procedures. Date and time of NPO periods were recorded as well as the physician's postoperative diet orders and diet progression. Surgical procedures were classified as complex or noncomplex by the surgeons. Data were summarized and compared to published recommendations. RESULTS Preoperative NPO times were greater than recommended in 70% of patients studied (n=37). Median time spent NPO preoperatively was not significantly different between complex (11.5h) and noncomplex groups (10.8h). Postoperative NPO time was significantly greater for complex procedures than for noncomplex. Most patients received some postoperative NPO time, even when it was not included in the physician diet order. CONCLUSION Observed preoperative NPO time exceeded current recommendations in this study.
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Affiliation(s)
| | - Mariska Simons
- Department of Agricultural, Life, and Environmental Sciences, University of Alberta.
| | - Amanda Evasiuk
- Department of Agricultural, Life, and Environmental Sciences, University of Alberta.
| | - Vera Mazurak
- Department of Agricultural, Life, and Environmental Sciences, University of Alberta.
| | - Bryan Dicken
- Department of Pediatrics, University of Alberta.
| | | | - Bodil Larsen
- Nutrition Services, Alberta Health Services; Department of Agricultural, Life, and Environmental Sciences, University of Alberta; Department of Pediatrics, University of Alberta.
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Song IK, Kim HJ, Lee JH, Kim EH, Kim JT, Kim HS. Ultrasound assessment of gastric volume in children after drinking carbohydrate-containing fluids. Br J Anaesth 2016; 116:513-7. [DOI: 10.1093/bja/aew031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Kushnir J, Djerassi R, Sofer T, Kushnir T. Threat perception, anxiety and noncompliance with preoperative fasting instructions among mothers of children attending elective same day surgery. J Pediatr Surg 2015; 50:869-74. [PMID: 25783336 DOI: 10.1016/j.jpedsurg.2014.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/19/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The current study examined possible links between threat perception, anxiety, conscientiousness and parental noncompliance with preoperative fasting instructions for their children. METHODS 100 mothers of children about to undergo an ambulatory elective surgery were divided to two equal groups based on compliance/noncompliance with pre surgery fasting requirements. Logistic regression analysis was preformed to predict compliance/noncompliance. In addition a logistic model estimating the effect of anxiety and conscientiousness levels, and their interaction, on the probability of fasting was performed. RESULTS Mothers who did not comply with fasting requirements perceived the procedure as more threatening, were more anxious and had lower conscientiousness levels. Additionally, mother's anxiety prior to surgery mediated the association between mothers' threat perception and compliance. Finally, conscientiousness moderated the anxiety and compliance association so that high conscientiousness levels reduced the effect of anxiety, elevating the likelihood of anxious mothers to comply with fasting guidelines. CONCLUSIONS Based on these findings we recommend medical staff to make significant efforts to identify highly anxious parents as early as possible during the preoperative process. Innovative assessment and intervention tools should be developed in order to conduct a smooth medical operation and reduce the chance of unnecessary and costly surgery cancelation.
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Affiliation(s)
- Jonathan Kushnir
- School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel; The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | | | - Tamar Sofer
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Talma Kushnir
- Department of Public Health, Ben-Gurion University of the Negev, Israel
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Schmidt A, Buehler P, Seglias L, Stark T, Brotschi B, Renner T, Sabandal C, Klaghofer R, Weiss M, Schmitz A. Gastric pH and residual volume after 1 and 2 h fasting time for clear fluids in children †. Br J Anaesth 2015; 114:477-82. [DOI: 10.1093/bja/aeu399] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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[Preoperative fasting guidelines: an update]. ACTA ACUST UNITED AC 2014; 62:145-56. [PMID: 25443866 DOI: 10.1016/j.redar.2014.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 11/22/2022]
Abstract
Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery.
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Andersen C, Afshari A. Impact of perioperative hyponatremia in children: A narrative review. World J Crit Care Med 2014; 3:95-101. [PMID: 25374805 PMCID: PMC4220142 DOI: 10.5492/wjccm.v3.i4.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 09/13/2014] [Accepted: 10/27/2014] [Indexed: 02/06/2023] Open
Abstract
For more than 50 years, hypotonic fluids (crystalloids) have been the standard for maintenance fluid used in children. In the last decade, several studies have evaluated the risk of hyponatremia associated with the use of hypotonic vs isotonic fluids, which has lead to an intense debate. Children undergoing surgery have several stimuli for release of antidiuretic hormone, which controls renal water handling, including pain, nausea, vomiting, narcotic use and blood loss. The body’s primary defense against the development of hyponatremia is the ability of the kidneys to excrete free water and dilute urine. Increased levels of antidiuretic hormone can result in hyponatremia, defined as a plasma sodium level < 136 mmol/L, which causes cells to draw in excess water and swell. This manifests as central nervous system symptoms such as lethargy, irritability and seizures. The risk for symptomatic hyponatremia is higher in children than in adults. It represents an emergency condition, and early diagnosis, prompt treatment and close monitoring are essential to reduce morbidity and mortality. The widespread use of hypotonic fluids in children undergoing surgery is a matter of concern and more focus on this topic is urgently needed. In this paper, we review the literature and describe the impact of perioperative hyponatremia in children.
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Gebremedhn EG, Nagaratnam VB. Audit on preoperative fasting of elective surgical patients in an African academic medical center. World J Surg 2014; 38:2200-4. [PMID: 24748347 PMCID: PMC4124256 DOI: 10.1007/s00268-014-2582-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Preoperative fasting is a requisite before anesthesia. The main reason for preoperative fasting is to reduce gastric volume and acidity and thus decrease the risk of pulmonary aspiration. However, preoperative fasting is usually prolonged beyond the recommended time for various reasons. Despite the many adverse effects of prolonged fasting, patients sometimes fasted for a prolonged time when surgery was delayed for different reasons at the University of Gondar Hospital. The aim of this study was to assess the duration of preoperative fasting for elective surgery. METHODS A cross-sectional study was conducted from March 10 to April 10, 2013. Patients were interviewed 24 h after surgery. All 43 patients who were under anesthesia while operated on during the study period were included. RESULT Of the 43 patients included in the study, 35 were adults and 8 were children. The minimum, maximum, and mean fasting hours for food were 5, 96, and 19.60, respectively, and more than 50 % of the patients fasted from food twice as long as recommended. The minimum, maximum, and mean fasting hours for fluid were 5, 19, and 12.72, respectively. More than 95 % of the patients fasted from fluid longer than recommended. CONCLUSION Most patients fasted from both food (92 %) and fluid (95 %) longer than the fasting time recommended by the AAGBI, ASA, RCOA, and RCN fasting guidelines. Anesthetists, surgeons, and nurses need to revise operation lists every day in the operating theatres and resuscitate the patients when surgery is delayed for various reasons. A preoperative fasting guideline should be developed and implemented in the University of Gondar Hospital.
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Affiliation(s)
- Endale Gebreegziabher Gebremedhn
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gonder, Ethiopia
| | - Vidhya Bates Nagaratnam
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gonder, Ethiopia
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Williams C, Johnson PA, Guzzetta CE, Guzzetta PC, Cohen IT, Sill AM, Vezina G, Cain S, Harris C, Murray J. Pediatric fasting times before surgical and radiologic procedures: benchmarking institutional practices against national standards. J Pediatr Nurs 2014; 29:258-67. [PMID: 24365219 DOI: 10.1016/j.pedn.2013.11.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 12/11/2022]
Abstract
Prolonged preoperative fasting can be associated with adverse outcomes, particularly in children. Our aims were to assess the time pediatric patients fasted prior to surgical or radiologic procedures and evaluate whether fasting (NPO) orders complied with national guidelines. We measured NPO start time, time of last intake, and time test or surgery was scheduled, took place, or was cancelled in 219 pediatric patients. Findings demonstrate that pediatric patients experienced prolonged fasting before procedures and that the majority of NPO orders were non-compliant with national guidelines. We have developed strategies to reduce fasting times and ensure compliance with recommended national fasting standards.
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Affiliation(s)
| | | | - Cathie E Guzzetta
- Children's National Medical Center, Washington, DC; School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Philip C Guzzetta
- Children's National Medical Center, Washington, DC; George Washington University, Washington, DC
| | - Ira Todd Cohen
- School of Medicine and Health Sciences, George Washington University, Washington, DC; Department of Anesthesiology and Pain Medicine, Children's National Medical Center, Washington, DC
| | - Anne M Sill
- Division of Biostatistics and Study Methodology, Center for Translational Science, Children's National Medical Center, Washington, DC
| | - Gilbert Vezina
- Children's National Medical Center, Washington, DC; School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Sherry Cain
- Children's National Medical Center, Washington, DC
| | | | - Jodi Murray
- Children's National Medical Center, Washington, DC
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