Withholding oral fluids from children undergoing day surgery reduces vomiting

Abstract

The effect of withholding oral fluids on the incidence of postoperative vomiting was evaluated in 317 children undergoing day surgery. Children were randomized by cohort into one of two groups either drinking oral fluids or having oral fluids withhold for 4-6 h postoperatively. All patients received replacement intravenous fluids sufficient to cover the anticipated fasting period. Vomiting was assessed in hospital through to the first postoperative day. Compliance to the protocol was excellent. The incidence of vomiting in the group with fluids withheld was significantly less than (P < 0.004) that of the group which drank (38% vs 56%). This difference was seen whether or not patients thought to be at high risk for postoperative vomiting (strabismus or adenoidectomy +/- tonsillectomy) were included in the analysis. The greatest effect of withholding oral fluids was seen in patients receiving opioids (P < 0.001) where vomiting was reduced from 73% to 36%. Withholding oral fluids postoperatively from children undergoing day surgery reduces the incidence of vomiting.

The role of oral fluid intake following adeno-tonsillectomy

“…Parental survey of this cohort demonstrated no difference between the two groups in terms of oral intake, comfort level, patient alertness or rate of complications after discharge [15]. Kearney et al detected significantly lower rates of emesis (38% versus 56%) when oral fluids were withheld for 4-6 h post-operatively in a study of 317 pediatric patients undergoing outpatient surgery [11]. Finally, in a large study of pediatric patients, Schreiner et al randomized 464 patients to mandatory drinking and 525 to elective drinking.…”

“…Inability to tolerate oral liquids and refractory emesis occur in up to 30% of cases and represent the most common indications for unscheduled admission following T&A [10][11][12][13]. Multiple anesthetic, surgical, post-operative and patient related factors have been linked to dysphagia and emesis in this setting.…”

“…Several studies, however, have demonstrated prolonged hospitalization and higher rates of emesis for patients receiving a mandatory trial of oral liquids without an associated improvement in determining ''fitness'' when compared to patients who are not required to drink prior to discharge. These reports argue that an oral liquid challenge may not be necessary or even appropriate in this setting [10][11][12]15]. Our institutional experience has noted a shift over the past decade in the management of pediatric patients undergoing T&A with less stringent criteria for discharge in terms of age, history of sleep apnea and ability to tolerate liquids post-operatively.…”

Factors affecting recovery and discharge following ambulatory surgery

“…In the Kearney et al study, children were randomly allocated in the postoperative period to one of two groups; drinking oral fluids or having oral fluids withheld for four to six hours postoperatively. 30 The incidence of vomiting in the group with fluids withheld was significantly less than the group of patients who drank. The greatest effect of withholding oral fluids was observed in patients who received opioids, where vomiting was reduced from 73% to 36%.…”

“…The studies that changed practices in the ambulatory setting are: Schreiner and Kearney et al 29,30 in the pediatric population and Jin et al 31 in the adult population. Schreiner et al assigned children undergoing ambulatory surgery into either "mandatory drinker" or "elective drinker" groups.…”