Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite

Andersson, Hanna; Zarén, Birgitta; Frykholm, Peter

doi:10.1111/pan.12667

Cited by 132 publications

(125 citation statements)

References 29 publications

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“…Despite these findings, observational studies show that excessive fasting remains common practice at children's hospitals and that optimized preoperative fasting times closely following the current guidelines (6‐4‐2‐rule) are effective in decreasing the ketone body concentration and stabilizing arterial blood pressure, particularly in young children . Other studies have found no differences in the gastric contents 4 or 6 hours after a light meal, and no increased incidence of pulmonary aspiration was observed after clear fluids were given less than 2 hours preoperatively …”

Section: Choosing Wisely In Pediatric Anesthesia: 10 Dos and Don′tsmentioning

confidence: 99%

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Becke

Eich

Höhne

et al. 2018

Pediatric Anesthesia

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Inspired by the Choosing Wisely initiative, a group of pediatric anesthesiologists representing the German Working Group on Paediatric Anaesthesia (WAKKA) coined and agreed upon 10 concise positive ("dos") or negative ("don'ts") evidence-based recommendations. (i) In infants and children with robust indications for surgical, interventional, or diagnostic procedures, anesthesia or sedation should not be avoided or delayed due to the potential neurotoxicity associated with the exposure to anesthetics. (ii) In children without relevant preexisting illnesses (ie, ASA status I/II) who are scheduled for elective minor or medium-risk surgical procedures, no routine blood tests should be performed. (iii) Parental presence during the induction of anesthesia should be an option for children whenever possible. (iv) Perioperative fasting should be safe and child-friendly with shorter real fasting times and more liberal postoperative drinking and enteral feeding. (v) Perioperative fluid therapy should be safe and effective with physiologically composed balanced electrolyte solutions to maintain a normal extracellular fluid volume; addition of 1%-2.5% glucose to avoid lipolysis, hypoglycemia, and hyperglycemia, and colloids as needed to maintain a normal blood volume. (vi) To achieve safe and successful airway management, the locally accepted airway algorithm and continued teaching and training of basic and alternative techniques of ventilation and endotracheal intubation are required. (vii) Ultrasound and imaging systems (eg, transillumination) should be available for achieving central venous access and challenging peripheral venous and arterial access. (viii) Perioperative disturbances of the patient's homeostasis, such as hypotension, hypocapnia, hypothermia, hypoglycemia, hyponatremia, and severe anemia, should not be ignored and should be prevented or treated immediately. (ix) Pediatric patients with an elevated perioperative risk, eg, preterm and term neonates, infants, and critically ill children, should be treated at institutions where all caregivers have sufficient expertise and continuous clinical exposure to such patients. (x) A strategy for preventing postoperative vomiting, emergence delirium, and acute pain should be a part of every anesthetic procedure.

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Section: Choosing Wisely In Pediatric Anesthesia: 10 Dos and Don′tsmentioning

confidence: 99%

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Becke

Eich

Höhne

et al. 2018

Pediatric Anesthesia

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“…Pulmonary aspiration is rare event with the modern techniques of anesthesia. Anderson et al 4 found an incidence of 0.03% of pulmonary aspiration in more than 10,000 elective surgical procedures in pediatrics.…”

Section: Discussionmentioning

confidence: 99%

“…However, in the literature there are studies showing that the gastric emptying time in healthy children is relatively short and prolonged fasting exacerbates the metabolic status of patients. There is a greater concentration of ketone bodies in the blood plasma of children who spent more than 4 h of fasting compared to those with only 2 h, indicating that fasting increases catabolism, increasing surgical stress 4 .…”

Section: Introductionmentioning

confidence: 99%

Changing Paradigms in Preoperative Fasting: Results of a Joint Effort in Pediatric Surgery

Carvalho

Carvalho²,

Nogueira

et al. 2017

ABCD, arq. bras. cir. dig.

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Background: Current researches associate long fasting periods to several adverse consequences. The fasting abbreviation to 2 h to clear liquids associated with the use of drinks containing carbohydrates attenuates endocrinometabolic response to surgical trauma, but often is observed children advised to not intake food from 00:00 h till the scheduled surgical time, regardless of what it is. Aim: To evaluate the safety of a protocol of preoperative fasting abbreviation with a beverage containing carbohydrates, and early postoperative feeding in children underwent elective small/mid-size surgical procedures during a national task-force on pediatric surgery. Methods: Thirty-six patients were prospectively included, and for several reasons five were excluded. All 31 who remained in the study received a nutritional supplement containing 150 ml of water plus 12.5% maltodextrin 2 h before the procedure. Data of the pre-operative fasting time, anesthetic complications and time of postoperative refeeding, were collected. Results:Twenty-three (74.2%) were males, the median age was 5 y, and the median weight was 20 kg. The median time of pre-operative fasting was 145 min and the time of post-operative refeeding was 135 min. There were no adverse effects on the anesthetic procedures or during surgery. Post-operatively, two children (6.5%) vomited. Conclusion: The abbreviation of pre-operative fasting to 2 h with beverage containing carbohydrate in pediatric surgery is safe. Early refeeding in elective small/mid-size procedures can be prescribed.

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“…However, shortening to a 6–4–0+ fasting regime may become a more widely accepted pediatric practice 19–21. Delivering a 2-hour absolute fasting time can be challenging, even in scheduled elective surgery.…”

Section: Perioperative Carementioning

confidence: 99%

Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

Robinson

Engelhardt

2017

LRA

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PurposeMyringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT) surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction.Recent findingsThis review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED) and emergence agitation (EA). New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed.SummaryLong-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6–4–0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up.

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Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite

Abstract: Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite.

Cited by 132 publications

References 29 publications

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Changing Paradigms in Preoperative Fasting: Results of a Joint Effort in Pediatric Surgery

Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

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