Effect of fasting time before anesthesia on postoperative complications in children undergoing adenotonsillectomy

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.

Preoperative fasting and the risk of pulmonary aspiration—a narrative review of historical concepts, physiological effects, and new perspectives

“…During long periods of fasting, children also experience thirst, hunger, anxiety, vomiting, and pain. 117 , 118 , 119 Prolonged preoperative fasting may be a risk factor for postoperative emergence delirium in children. 120 , 121 Optimised preoperative fasting management reduces fasting time, decreases ketone body concentration, and helps to stabilise mean arterial blood pressure during induction of anaesthesia in children.…”

The actual duration of preoperative fasting in pediatric patients, and its effects on hunger and thirst: a prospective observational study

“…The mean fasting times for food and clear liquid were 7.8-14.0 h (12-24) and 2.3-12.3 h, respectively (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Multiple perioperative complications had been described after extensive fasting such as hypotension after anesthesia induction (25,26), ketosis (23), increased incidence of postoperative nausea and vomiting (27), and patient discomfort (16). Carbohydrate-rich drink was reported to reduce hunger, thirst and anxiety in adults (28,29) but not in pediatrics (30,31).…”

Jejum pré-anestésico repetitivo em pacientes submetidos a radioterapia pediátrica sob sedação: importância da implantação de um protocolo específico de abreviação do jejum

“…Todavia, é bem descrito na literatura que o jejum prolongado pode ocasionar diversas complicações em crianças que o vivenciam, como maior sensação de fome e sede, desidratação, desconforto e irritabilidade [3][4][5][6] . Ademais, o jejum prolongado potencializa a reposta metabólica ao trauma, reduzindo os estoques de glicogênio, ocasionando um aumento da gliconeogênese, maior catabolismo proteico, além do aumento da resistência à insulina e hiperglicemia no pós-operatório 7 .…”