Preoperative Fluid Fasting Times and Postinduction Low Blood Pressure in Children

Simpao, Allan F.; Wu, Lezhou; Nelson, Olivia; Gálvez, Jorge A.; Tan, Jonathan M.; Wasey, Jack O.; Muhly, Wallis T.; Tsui, Fu-Chiang; Masino, Aaron J.; Stricker, Paul A.

doi:10.1097/aln.0000000000003343

Cited by 54 publications

(44 citation statements)

References 36 publications

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“…However, the evidence for reduction in postoperative complications by providing preoperative carbohydrate drinks is debatable [25,26]. Prolonged fasting from clear fluids has also been shown to complicate the induction of anaesthesia, with patients fasted for prolonged periods having a significantly lower blood pressure during induction within a paediatric population [4].…”

Section: Introductionmentioning

confidence: 99%

Fasting and surgery timing (FaST) audit

El‐Sharkawy¹,

Daliya²,

Lewis‐Lloyd³

et al. 2021

Clinical Nutrition

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Summary Background & aims International guidance advocates the avoidance of prolonged preoperative fasting due to its negative impact on perioperative hydration. This study aimed to assess the adherence to these guidelines for fasting in patients undergoing elective and emergency surgery in the East Midlands region of the UK. Methods This prospective audit was performed over a two-month period at five National Health Service (NHS) Trusts across the East Midlands region of the UK. Demographic data, admission and operative details, and length of preoperative fasting were collected on adult patients listed for emergency and elective surgery. Results Of the 343 surgical patients included within the study, 50% (n = 172) were male, 78% (n = 266) had elective surgery and 22% (n = 77) underwent emergency surgery. Overall median fasting times (Q1, Q3) were 16.1 (13.0, 19.4) hours for food and 5.8 (3.5, 10.7) hours for clear fluids. Prolonged fasting >12 h was documented in 73% (n = 250) for food, and 21% (n = 71) for clear fluids. Median fasting times from clear fluids and food were longer in the those undergoing emergency surgery when compared with those undergoing elective surgery: 13.0 (6.4, 22.6) vs . 4.9 (3.3, 7.8) hours, and 22.0 (14.0, 37.4) vs . 15.6 (12.9, 17.8) hours respectively, p < 0.0001. Conclusions Despite international consensus on the duration of preoperative fasting, patients continue to fast from clear fluids and food for prolonged lengths of time. Patients admitted for emergency surgery were more likely to fast for longer than those having elective surgery.

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Section: Introductionmentioning

confidence: 99%

Fasting and surgery timing (FaST) audit

El‐Sharkawy¹,

Daliya²,

Lewis‐Lloyd³

et al. 2021

Clinical Nutrition

View full text Add to dashboard Cite

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“…Data extraction was based on 15 studies (Table 1, Ref. [2,[7][8][9][10][11][12][13][14][15][16][17][18][19]). These include studies on children ranging in age from preterm neonates at 28 weeks gestation to 18 years.…”

Section: Resultsmentioning

confidence: 99%

“…Children in the optimized group had lower blood ketones, higher mean arterial blood pressure at induction, and lower incidences of hypotension [8]. Simpao et al [9] also noted an association between clear fluid fasting times and low systolic arterial blood pressure after induction of anaesthesia and during surgical preparation.…”

Section: Metabolism and Hemodynamicsmentioning

confidence: 95%

Fasting in pediatric anesthesia: the art of making simple things complex

2021

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Prolonged preoperative fasting times for children scheduled for general anesthesia and surgery continue to be reported despite a plethora of recent studies suggesting that fasting for clear fluids can be shortened without increasing the risk of pulmonary aspiration. The aim of this narrative review was to summarize knowledge about the known benefits and potential consequences of prolonged fasting in pediatric anesthesia and to discuss the difficult implementation of reduced fasting times in clinical practice. This narrative review is based on fifteen studies published in the databases PubMed, EMBASE and Cinahl from October 2009 to June 2020. Outcome measures assessed were divided into 4 overall domains: metabolism and hemodynamics (1), patient comfort and patient/parent satisfaction (2), gastric volume and/or emptying time (3) and risk of pulmonary aspiration (4). While incidences of pulmonary aspiration remain low after implementation of less restrictive recommendations, the duration of fasting times relates to negative outcomes (low post-induction blood pressure, increase of blood ketones, poor patient/parent satisfaction). Preoperative fasting times must balance the risk of aspiration during anesthesia against children’s wellbeing and metabolic homeostasis. Based on the current evidence on preoperative fasting in children, liberal fasting times with nil-per-mouth for solids and formulas, breast milk and clear fluids corresponding to 6, 4 and 1 hours respectively, are safe. However, a reduction in real fasting times is pending and requires a multifactorial approach.

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“…4 Hypoglycemia and dehydration may manifest as hemodynamic instability at the time of anesthesia induction and cause significant harm. [5][6][7] Finally, prolonged durations of fasting could result in high rates of noncompliance and may thus compromise the goals of aspiration prevention and patient safety.…”

Section: Perioperative Medicinementioning

confidence: 99%

Ultrasound Evaluation of Gastric Emptying Time in Healthy Term Neonates after Formula Feeding

et al. 2021

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Background The current American Society of Anesthesiologists fasting guideline for formula-fed infants in the periprocedural setting is 6 h. Prolonged fasting in very young infants is associated with an increased risk for hypoglycemia and dehydration as well as patient discomfort and patient/parental dissatisfaction. This study aimed to determine the time to gastric emptying in healthy neonates after formula feeding by serially evaluating the gastric antrum with ultrasound. The authors hypothesized that gastric emptying times in formula-fed neonates are significantly shorter than the current 6 h fasting recommendation. Methods After institutional review board approval and written informed parental consent, ultrasound examination was performed in healthy full-term neonates before and after formula feeding at 15-min intervals until return to baseline. Ultrasound images of the gastric antrum were measured to obtain cross-sectional areas, which were then used to estimate gastric antral volumes. Results Forty-six of 48 recruited neonates were included in the final analysis. Gastric emptying times ranged from 45 to 150 min and averaged 92.9 min (95% CI, 80.2 to 105.7 min; 99% CI, 76.0 to 109.8 min) in the overall study group. No significant differences were found in times to gastric emptying between male and female neonates (male: mean, 93.3 [95% CI, 82.4 to 104.2 min]; female: mean, 92.6 [95% CI, 82.0 to 103.2 min]; P = 0.930) or those delivered by vaginal versus cesarean routes (vaginal: mean, 93.9 [95% CI, 81.7 to 106.1 min]; cesarean: mean, 92.2 [95% CI, 82.5 to 101.9 min]; P = 0.819). Conclusions These results demonstrate that gastric emptying times are substantially less than the current fasting guideline of 6 h for formula-fed, healthy term neonates. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Preoperative Fluid Fasting Times and Postinduction Low Blood Pressure in Children

Cited by 54 publications

References 36 publications

Fasting and surgery timing (FaST) audit

Fasting and surgery timing (FaST) audit

Fasting in pediatric anesthesia: the art of making simple things complex

Ultrasound Evaluation of Gastric Emptying Time in Healthy Term Neonates after Formula Feeding

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