New ESAIC fasting guidelines for clear fluids in children

Abstract

This Invited Commentary accompanies the following original article: Frykholm P, Disma N, Anders-son H, et al. Preoperative fasting in children: guideline from the European Society of Anaesthe-siology and Intensive Care.

Response to: reply to: New ESAIC fasting guidelines for clear fluids in children

“…We all agree that the metabolic and clinical risks associated with prolonged fasting and the benefits of preoperative oral clear fluids in children reviewed in the new ESAIC Fasting guidelines and my Commentary 5 are of limited significance in Western medicine. Here the authors speculate that their 1 h fasting limit after clear fluids will have global appeal to address preoperative hypoglycemia, which occurred in 26% of children in one study from Addis Ababa 7 .…”

“…I also contend that clinical observational studies that advocate a 1 h fast after clear fluids do not provide reassurance that the 1 h fast is well tolerated because, as the authors point out, in clinical practice, most children fast for much more than 1 h after clear fluids! In addition, I summarised in my Commentary that the published evidence points to a greater risk of regurgitation and suspected aspiration with a 1 h fast than with a longer fast 5 . Compounding all of these concerns is the large variability in gastric emptying after clear fluids.…”

“…In addition, I summarised in my Commentary that the published evidence points to a greater risk of regurgitation and suspected aspiration with a 1 h fast than with a longer fast. 5 Compounding all of these concerns is the large variability in gastric emptying after clear fluids. A child who ingests large volumes of clear fluids may have a large residual volume in the stomach after 1 h, which poses an uncontrollable and unknown risk at induction of anaesthesia, which few clinicians wish to face.…”

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the most important benefit is to reduce the number of children fasting overnight or longer when there is no need, as supported by several recent publications. [3][4][5]

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Reply to: New ESAIC fasting guidelines for clear fluids in children

“…We read with interest Professor Lerman's opinion paper commenting on the recently published ESAIC guideline on pre-operative fasting in children 1 . The guideline paper presented the results of a systematic review of the literature and the subsequent development of a 26-item guideline, using state-of-the-art methodology 2 .…”