Preoperative fasting in children: An audit and its implications in a tertiary care hospital

Abstract

Background:Prolonged preoperative fasting in children is a common problem, especially in highvolume centers. All international professional society guidelines for preoperative fasting recommend 2 h for clear fluids, 4 h for breast milk and 6 h for solids, nonhuman and formula milk in children. These guidelines are rarely adhered to in practice.Aims:An audit was undertaken to determine the length of preoperative fasting time in children and its causes.Settings and Design:Cross-sectional study of 50 children below 15 years posted for elective surgeries.Materials and Methods:An initial audit was performed at our institution on preoperative fasting time in 50 children below 15 years of age for elective surgeries. The mean preoperative fasting times were found to be much longer than the recommended times. Ward nurses were then educated about internationally recommended preoperative fasting guidelines in children. Anesthesiologists started coordinating with surgeons and ward nurses to prescribe water for children waiting for more than 2 h based on changes in surgery schedule by instructing ward nurses through telephone on the day of surgery. A reaudit was done 6 months after the initial audit.Statistical Analysis Used:SPSS 16 software.Results:The initial audit revealed a mean preoperative fasting time of 11.25 h and 9.25 h for solids and water, respectively. Incorrect orders by ward nurses (74%) and change in the surgical schedule (32%) were important causes. After changing the preoperative system, mean preoperative fasting times in children decreased to 9 h and 4 h for solids and water, respectively in reaudit. Change in surgical schedule (30%) was the major cause for prolonged preoperative fasting in reaudit.Conclusions:Simple steps such as education of ward nurses and better coordination among the anesthesiologists, surgeons and nurses can greatly reduce unnecessary preoperative starvation in children.

Threat perception, anxiety and noncompliance with preoperative fasting instructions among mothers of children attending elective same day surgery

“…In another recent study, the authors even suggested that parents may deliberately misrepresent the actual fasting status of their child [17]. However, it is important to note that parental noncompliance with preoperative fasting guidelines may be caused by lack of understanding or incorrect orders of medical staff [18].…”

Audit on Preoperative Fasting of Elective Surgical Patients in an African Academic Medical Center

“…Therefore, the order NPO starting at midnight for elective surgery can be adjusted to no intake of solid food and milk products 6 h before surgery and fast from clear fluid 2 h before surgery [4–10]. …”

Excessive fasting times: still an underaddressed challenge for African pediatrics and anesthesia?

“…9,10 The MFT at Queen Elizabeth Central Hospital was too long in each of the clinical audits conducted over the last 5 years. Reasons mentioned for long fasting times in the developed world -nurses still order "nil by mouth after midnight", that they dealt with an outpatient population 3 or that obviously wrong information was given to secure timely flexibility for the theatre 18 were not typical for our hospital. Children being starved of water for a mean of 8.5 hours, as at our institution, exceeds the recommendations of all international guidelines.…”

“…1,2 Nevertheless, prolonged periods of preoperative fasting are still reported. [3][4][5][6] Data for resource-poor African countries are scarce, 7,8 and long-term audits are lacking. At Queen Elizabeth Central Hospital, which is the largest hospital in Malawi, we identified that preoperative starving times were longer than the standards set by the anesthetic department.…”