A prospective study of paediatric preoperative fasting times at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

Abstract

Background. Fasting for liquids and solids is recommended prior to procedures requiring anaesthesia, to reduce the risk of pulmonary aspiration. Children often experience excessive fasting, which is associated with negative physiological and behavioural consequences, and patient discomfort. The duration of preoperative fasting in children in South Africa (SA) is unknown. Objectives. To determine compliance with fasting guidelines and fasting times of children prior to elective procedures performed under anaesthesia at a paediatric hospital in Cape Town, SA. The primary focus was fasting for clear liquid. We also intended to identify the most common reasons for prolonged clear liquid fasting. Methods. Over a 7-week period, we prospectively captured fasting times of consecutive patients undergoing elective surgical, medical and radiological procedures at Red Cross War Memorial Children's Hospital. Measurement outcomes were defined as the period from the last clear liquid, milk or solid feed to the start of anaesthesia. For analysis of compliance with preoperative fasting guidelines, institutional preoperative fasting target limits were established based on the standard 6-4-2-hour guideline.Results. The study included 721 elective paediatric cases. The mean (standard deviation (SD)) fasting time for clear liquids (n=585) was 8.0 (4.8) hours, with an adherence rate of 25.5% (95% confidence interval 22 -29) to the institutional target of 2 -4 hours. The mean (SD) fasting times for breastmilk (n=92), formula milk (n=116) and solid feeds (n=560) were 7.1 (2.8), 8.8 (2.8) and 13.9 (3.6) hours, respectively. The factors associated with clear liquid fasting >4 hours were inadequate fasting instructions, poor adherence to fasting orders, procedural delays and fasting to promote theatre flexibility. Conclusions. This study demonstrates that children in an SA hospital experience excessive fasting times prior to elective procedures. To reduce fasting durations and improve the quality of perioperative care, quality improvement interventions are required to create an adaptable fasting system that allows individualised fasting. Improving preoperative fasting times in children is the responsibility of all healthcare professionals in the multidisciplinary management team.

ERAS in Tonsil Adenoid Surgery in Children

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

Ações de cuidado no preparo pré-operatório à criança submetida a procedimentos cirúrgicos

“…19 O jejum prolongado pré-operatório, em que os pacientes não podem ingerir líquidos ou sólidos por via oral, 13 para garantir o esvaziamento gástrico e evitar a broncoaspiração durante o procedimento cirúrgico 11 não apresenta uma boa adesão. 5 A redução do tempo de jejum de líquidos irá resultar em benefícios consideráveis, mitigando o emocional negativo, comportamento, bioquímico e hemodinâmico e melhoria dos escores de dor. 8 Os tempos de jejum prolongado causa um desequilíbrio da homeostase metabólica, diminuição da pressão arterial, cetoacidose e tem um efeito negativo no estado de hidratação, causando irritabilidade na criança, reduzindo a satisfação dos pais, 13 fome e sede intensos resultaram numa experiência pré-operatória ruim para crianças.…”

Pro-Con Debate: 1- vs 2-Hour Fast for Clear Liquids Before Anesthesia in Children

“…Toward Solving the Prolonged Fast: Better Communication Parental noncompliance with the 2-hour fast after clears has been attributed to a panoply of reasons, [71][72][73][74][75] leading to our senses of frustration and futility in resolving this issue. Two quality improvement studies streamlined hard-copy instructions to parents, reminded parents to follow the 2-hour fast after clears in a phone call on the evening before surgery, and included oral administration of limited clear liquids in hospital to select patients.…”