Using quality improvement methods to reduce clear fluid fasting times in children on a preoperative ward

Section: Discussionmentioning

confidence: 93%

Ultrasound assessment of the prevalence of increased gastric contents and volume in elective pediatric patients: A prospective cohort study

Bouvet

Bellier

Gagey-Riegel

et al. 2018

“…Andersson et al showed that dispensing with the 2 hours fasting limit for clear fluids was not associated with an increased incidence of pulmonary aspiration, and other studies found that the stomach processes a light meal in less than 4 hours . For a better implementation of improved fasting regimens, Newton et al favored a structured quality improvement program leading to an increased proportion of children fasting less than 4 hours after the introduction of a standard operating procedure checking the fasting status on admission and allowing clear fluids up to 1 hour before anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Shortened fasting times may improve the metabolic and hemodynamic condition during induction of anesthesia and the perioperative experience for parents and children with a low risk of aspiration and simplify perioperative management. As a consequence, some centers have reduced the fasting requirements for clear fluids to 1 hour and for light meals to 4 hours . In a recent review, Frykholm et al suggested that this change should be done ideally within a framework of a large multicenter audit monitoring the benefits and safety of the more liberal fasting regimen.…”

Section: Introductionmentioning

confidence: 99%

Real fasting times and incidence of pulmonary aspiration in children: Results of a German prospective multicenter observational study

Beck

Rudolp

Becke‐Jakob

et al. 2019

Background Prolonged fasting before anesthesia is still common in children. Shortened fasting times may improve the metabolic and hemodynamic condition during induction of anesthesia and the perioperative experience for parents and children and simplify perioperative management. As a consequence, some centers in Germany have reduced fasting requirements, but the national guidelines are still unchanged. Aims This prospective multicenter observational study was initiated by the Scientific Working Group for Pediatric Anesthesia of the German Society of Anesthesiology and Intensive Care Medicine to evaluate real fasting times and the incidence of pulmonary aspiration before a possible revision of national fasting guidelines. Methods After the Ethics Committee's approval, at least 3000 children were planned to be enrolled for this analysis. Patient demographics, real fasting times, anesthetic and surgical procedures and occurrence of regurgitation or pulmonary aspiration were documented using a standardized case report form. Results were presented as median [interquartile range] (range) or incidence (percentage). Results At ten pediatric centers, 3324 children were included between October 2018 and May 2019. The real fasting times for large meals were 14 [12.2‐15.6] (0.5‐24) hours, for light meals 9 [5.6‐13.3] (0.25‐28.3) hours, for formula milk 5.8 [4.5‐7.4] (0.9‐24) hours, for breast milk 4.8 [4.2‐6.3] (1.3‐25.3) hours and for clear fluids 2.7 [1.5‐6] (0.03‐22.8) hours. Prolonged fasting (deviation from guideline >2 hours) was reported for large meals in 88.3%, for light meals in 54.7%, for formula milk in 44.4%, for breast milk in 25.8% and for clear fluids in 34.2%. Eleven cases (0.33%) of regurgitation, four cases (0.12%) of suspected pulmonary aspiration and two cases (0.06%) of confirmed pulmonary aspiration were reported; all of them could be extubated after the end of the procedure and recovered without any incidents. Conclusion This study shows that prolonged fasting is still common in pediatric anesthesia in Germany that pulmonary aspiration with postoperative respiratory distress is rare and that improvements to current local fasting regimens and national fasting guidelines are urgently needed.

“…Children undergoing an elective procedure under general anesthesia are required to fast to avoid the presence of solid gastric contents and lower the risks of regurgitation and pulmonary aspiration. A prolonged fasting time for clear fluids can have adverse effects, such as hunger, discomfort, headache, dehydration, hypovolemia, and hypoglycemia, and as a result, some pediatric hospitals have engaged in projects to reduce their preoperative fasting times for clear liquids . Dehydration and hypovolemia can increase the difficulty of establishing vascular access, though this association has not been clearly established in the literature.…”

Section: Introductionmentioning

confidence: 99%

Duration of preoperative clear fluid fasting and peripheral intravenous catheterization in children: A single‐center observational cohort study of 9693 patients

Gálvez

Simpao

et al. 2019

Background Children routinely undergo inhalational induction of general anesthesia. Intravenous line placement typically occurs after induction of anesthesia and can be challenging, particularly in infants and young children. Aims We conducted a retrospective observational study to determine whether there was an association between clear liquid fasting time and the number of peripheral intravenous catheter insertion attempts in anesthetized children. The secondary aim was to identify factors associated with multiple attempts to insert intravenous lines. Methods After institutional research board approval, we retrieved a data set of all children between 0 months and 18 years who received general anesthesia at our hospital between January 1, 2016, and September 30, 2017. Data included age, gender, weight, race, ASA status, gestational age, number of peripheral intravenous catheter insertion attempts, any assistive device for insertion, and insertion site. Inclusion criteria were mask induction, ASA status 1 or 2, nonemergency, ambulatory surgical procedures, and placement of a single intravenous line during the anesthetic. Results A total of 9693 patients were included in the study. Of which 8869 patients required one insertion attempt and 824 underwent multiple insertion attempts. 50% of patients in the single insertion attempt group had clear liquid fasting time <6.9 hours compared to 51.8% of patients requiring multiple attempts. Logistic regression model adjusted for age, ASA status, gender, and BMI did not find an association between duration of clear liquid fasting time and rate of multiple insertion attempts for intravenous catheters (OR: 0.99, 95% CI: 0.98‐1.01, P = .47). Conclusion Clear liquid fasting time was not associated with multiple insertion attempts for intravenous line insertion in children receiving general anesthesia. Factors such as patient age, ethnicity, time of day of induction of anesthesia, and American Society of Anesthesiologists Physical Status classification show a greater association with the risk of multiple intravenous line insertion attempts.