A review of pediatric fasting guidelines and strategies to help children manage preoperative fasting

Abstract

Fasting for surgery is a routine step in the preoperative preparation for surgery. There have however been increasing concerns with regard to the high incidence of prolonged fasting in children, and the subsequent psycho‐social distress and physiological consequences that this poses. Additionally, the past few years have yielded new research that has shown significant inter‐individual variation in gastric emptying regardless of the length of the fast, with some patients still having residual gastric contents even after prolonged fasts. Additionally, multiple large‐scale studies have shown no long‐term sequalae from clear fluid aspiration, although two deaths from aspiration have been reported within the large Wake Up Safe cohort. This has led to a change in the recommended clear fluid fasting times in multiple international pediatric societies; similarly, many societies continue to recommend traditional fasting times. Multiple fasting strategies exist in the literature, though these have mostly been studied and implemented in the adult population. This review hopes to summarize the recent updates in fasting guidelines, discuss the issues surrounding prolonged fasting, and explore potential tolerance strategies for children.

State of the Art in Pediatric Anesthesia: A Narrative Review about the Use of Preoperative Time

“…Prolonged fasting can result in hypoglycemia, ketoacidosis/metabolic instability, electrolyte imbalance, or hemodynamic instability because of hypovolemia. Insulin resistance is also involved [100]. The latter arises from decreased insulin release and increased free fatty acids and is ex-acerbated during surgery due to increased stress hormone release (catecholamines, cortisol, glucagon).…”

“…Some authors highlighted that actual fasting times often exceed the minimums recommended by international guidelines [101]. The reason for this appears to be multifactorial and involves a lack of appropriate communication, operating theater delays, differing instructions, and noncompliance by parents [100]. Extended fasting not only affects physiological mechanisms but also negatively impacts the child's psychological state, leading to increased anxiety, sadness, and distress [102].…”

Effect of Preoperative Clear Liquid Consumption on Postoperative Recovery in Pediatric Patients Undergoing Minimally Invasive Repair of Pectus Excavatum: A Prospective Randomized Controlled Study

“…Shorter fasting periods can reduce dehydration and discomfort, potentially improving preoperative conditions without increasing the risk of aspiration. Recent discussions and studies suggest even shorter fasting times as little as 1 h for clear liquids [ 5 , 6 ]. However, these suggestions are still under investigation, and the current evidence supporting such changes is not yet strong enough to alter standard practice widely.…”