Preoperative Fasting Guidelines in Children: Should They Be Revised?

Abstract

Children presenting with ingestion of foreign bodies need gastroscopy as a primary management modality. A controversy lies regarding guidelines for preoperative fasting among children with low risk of aspiration and intraoperative complications. This case report represents cases of children who ingested foreign bodies and underwent fasting at different times preoperatively. With mounting evidence questioning the benefits of long durations of fasting in decreasing the risk of aspiration and with studies showing that fasting for more than 2 hours after ingestion of clear fluid does not significantly alter gastric pH or volume, these incidental findings raise the question of whether it is safe to keep children NPO, for a shorter duration before the administration of anesthesia. In addition, this report shows that current guidelines are in need of revision.

Fasted or Not: Anesthesia-Related Pulmonary Complications in Pediatric Orthopaedic Emergencies Are Rare: A Pilot Study

“…11 In a different study of pediatric patients undergoing endoscopic foreign body removal, it was found that fasting guidelines had no actual impact on the amount of gastric contents visualized during the procedure. 14,24 Not surprisingly, fasting for prolonged periods of time has been shown to lead to increased irritability, negative psychological effects, and a negative impact on metabolic activity in children. 15,25,26 This is historically a controversial topic with multiple sources either opposing or supporting strict adherence to fasting guidelines, necessitating a need for further work in this area.…”