Preoperative Fasting in the Pediatric Patient

Mapping Intimacies ◽

10.1093/med/9780190678333.003.0006 ◽

2018 ◽

Author(s):

Nancy Hagerman ◽

Eric Wittkugel

Keyword(s):

Pediatric Patient ◽

Venous Access ◽

Pulmonary Aspiration ◽

Evidence Based ◽

Rare Occurrence ◽

Preoperative Fasting ◽

Prolonged Fasting ◽

Gastric Contents ◽

Difficult Venous Access ◽

In Infants And Children

Preoperative fasting guidelines are designed to reduce the volume of gastric contents and to minimize the risk of pulmonary aspiration of gastric contents. Perioperative pulmonary aspiration in children is uncommon, with an incidence of between 1 and 10 per 10,000 anesthetics. It is associated with low morbidity and mortality. While fasting is important, it does not guarantee an empty stomach. Prolonged fasting in infants and children does not further reduce gastric volumes or increase safety but can be associated with unwanted effects such as irritability, parental dissatisfaction, hypoglycemia, dehydration, hypotension on the induction of anesthesia, difficult venous access, and possibly decreased compliance with the preoperative fast. Since pulmonary aspiration is a rare occurrence, few evidence-based recommendations for ideal fasting intervals exist. An understanding of the research involved in the creation of these guidelines is useful in ensuring the maximum safety of patients while minimizing the disadvantages of prolonged fasting.

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Preoperative Fasting in the Pediatric Patient

10.1093/med/9780199764495.003.0007 ◽

2013 ◽

Author(s):

Nancy S Hagerman ◽

Eric P Wittkugel

Keyword(s):

Pediatric Patient ◽

Pulmonary Aspiration ◽

Evidence Based ◽

Rare Occurrence ◽

Preoperative Fasting ◽

Prolonged Fasting ◽

Gastric Contents ◽

The Creation

Preoperative fasting guidelines are designed to minimize the risk of pulmonary aspiration of gastric contents. As pulmonary aspiration is a rare occurrence, however, few evidence-based recommendations for ideal fasting intervals exist. An understanding of the research involved in the creation of these guidelines is useful in ensuring the maximum safety of patients while minimizing the disadvantages of prolonged fasting.

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Preoperative Fasting Practices Across Three Anesthesia Societies: Survey of Practitioners

JMIR Perioperative Medicine ◽

10.2196/15905 ◽

2020 ◽

Vol 3 (1) ◽

pp. e15905 ◽

Cited By ~ 2

Author(s):

Richard Neville Merchant ◽

Navraj Chima ◽

Olle Ljungqvist ◽

Juliana Nai Jia Kok

Keyword(s):

Fluid Intake ◽

Evidence Base ◽

Pulmonary Aspiration ◽

Internet Survey ◽

Preoperative Fasting ◽

Clear Fluid ◽

Safety Issues ◽

Solid Foods ◽

Gastric Contents ◽

Operating Room Schedule

Background Pulmonary aspiration of gastric contents is recognized as a complication of anesthesia. To minimize that risk, anesthesiologists advised fasting for solid foods and liquids for an often prolonged period of time. However, 30 years ago, evidence was promulgated that fasting for clear liquids was unnecessary to ensure an empty stomach. Despite a strong evidence base and the knowledge that fasting may be physiologically harmful and unpleasant for patients, the adoption of society guidelines recommending short fasting periods for clear fluids into clinical practice is uncertain. Objective This study aimed to determine the current practices of anesthetists with respect to fasting guidelines. Methods An electronic internet survey was distributed to anesthetists in Canada (CAN), Australia and New Zealand (ANZ), and Europe (EUR) during April 2014 to February 2015. The anesthetists were asked about fasting guidelines, their recommendations to patients for the consumption of clear fluids and solid foods, and the reasons and consequences if these guidelines were not followed. Results A total of 971 anesthetists completed the survey (CAN, n=679; ANZ, n=185; and EUR, n=107). Although 85.0% (818/962) of these participants claimed that their advice to patients followed current society guidelines, approximately 50.4% (476/945) enforced strict fasting and did not allow clear fluids after midnight. The primary reasons given were with regard to problems with a variable operating room schedule (255/476, 53.6%) and safety issues surrounding the implementation of clear fluid drinking guidelines (182/476, 38.2%). Conclusions Many anesthetists continue to follow outdated practices. The current interest in further liberalizing preoperative fluid intake will require more change in anesthesia culture.

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Perioperative Pulmonary Aspiration in Infants and Children

Anesthesiology ◽

10.1097/00000542-199901000-00011 ◽

1999 ◽

Vol 90 (1) ◽

pp. 66-71 ◽

Cited By ~ 195

Author(s):

Mark A. Warner ◽

Mary E. Warner ◽

David O. Warner ◽

Louise O. Warner ◽

Jackson E. Warner

Keyword(s):

Respiratory Symptoms ◽

Postoperative Mortality ◽

Pulmonary Complications ◽

Pulmonary Aspiration ◽

Infants And Children ◽

Respiratory Morbidity ◽

General Anesthetics ◽

Emergency Procedures ◽

Gastric Contents ◽

In Infants And Children

Background Pulmonary aspiration of gastric contents during the perioperative period in infants and children may be associated with postoperative mortality or pulmonary morbidity. There has not been a recent determination of the frequency of this event and its outcomes in infants and children. Methods The authors prospectively identified all cases of pulmonary aspiration of gastric contents during the perioperative courses of 56,138 consecutive patients younger than 18 yr of age who underwent 63,180 general anesthetics for procedures performed in all surgical specialties from July 1985 through June 1997 at the Mayo Clinic. Results Pulmonary aspiration occurred in 24 patients (1: 2,632 anesthetics; 0.04%). Children undergoing emergency procedures had a greater frequency of pulmonary aspiration compared to those undergoing elective procedures (1:373 vs. 1:4,544, P < 0.001). Fifteen of the 24 children who aspirated gastric contents did not develop respiratory symptoms within 2 h of aspiration, and none of these 15 developed pulmonary sequelae. Five of these nine children who aspirated and in whom respiratory symptoms developed within 2 h subsequently had pulmonary complications treated with respiratory support (P < 0.003). Three children were treated with mechanical ventilation for more than 48 h, but no child died of sequelae of pulmonary aspiration. Conclusions In this study population, the frequency of perioperative pulmonary aspiration in children was quite low. Serious respiratory morbidity was rare, and there were no associated deaths. Infants and children with clinically apparent pulmonary aspiration in whom symptoms did not develop within 2 h did not have respiratory sequelae.

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Case Report: The use of gastric ultrasound to assess risk of pulmonary aspiration

POCUS Journal ◽

10.24908/pocus.v1i2.13254 ◽

2016 ◽

Vol 1 (2) ◽

pp. 8-9

Author(s):

James Cheng, PGY-4

Keyword(s):

Mechanical Ventilation ◽

Case Report ◽

General Anesthesia ◽

Elective Surgery ◽

Prolonged Mechanical Ventilation ◽

Pulmonary Aspiration ◽

Preoperative Fasting ◽

Patient Morbidity ◽

Gastric Contents ◽

American Society

Pulmonary aspiration of gastric contents is a dreaded complication of general anesthesia, as it carries significant patient morbidity and mortality. Subsequent aspiration pneumonia can lead to prolonged mechanical ventilation, and a mortality rate of up to 5%. To minimize the risk of pulmonary aspiration, patients are required – as per the American Society of Anesthesiology’s “Practice Guidelines for Preoperative Fasting” – to fast prior to elective surgery in order to ensure that the stomach is empty prior to induction of general anesthesia.

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Nil by mouth: A misleading statement

Journal of Perioperative Practice ◽

10.1177/175045890701700801 ◽

2007 ◽

Vol 17 (8) ◽

pp. 366-371 ◽

Cited By ~ 1

Author(s):

Manish Chand ◽

Natalie Dabbas

Keyword(s):

General Anaesthesia ◽

Drug Administration ◽

Pulmonary Aspiration ◽

Oral Medication ◽

Junior Doctors ◽

Preoperative Fasting ◽

Fasting Period ◽

Gastric Contents ◽

Misleading Statement ◽

Doctors And Nurses

Preoperative fasting is universally accepted as a beneficial practice to reduce the risk of pulmonary aspiration of gastric contents during the induction of general anaesthesia. What is less clear for many junior doctors and nurses is the administration of oral medication during the fasting period. This study aims to highlight the subjective understanding of the statement, ‘nil by mouth’, with regard to drug administration.

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Perioperative fasting: A review

Journal of Perioperative Practice ◽

10.1177/1750458919877591 ◽

2019 ◽

Vol 30 (7-8) ◽

pp. 204-209

Author(s):

Mark Dorrance ◽

Michael Copp

Keyword(s):

Best Practice ◽

Perioperative Period ◽

Pulmonary Aspiration ◽

Surgical Patients ◽

Preoperative Fasting ◽

Healthcare Staff ◽

Gastric Contents ◽

Current Guidelines ◽

Future Practice ◽

Review Current

Preprocedural/preoperative fasting is a key part of preparing a patient for undergoing sedation or anaesthesia to minimise the risk of pulmonary aspiration of gastric contents. As part of caring for elective surgical patients it is important that healthcare staff in the perioperative environment have a good understanding of both the current guidelines and underpinning evidence so that they can effectively manage preoperative patients. This article looks to summarise the latest guidelines regarding perioperative fasting for adult and paediatric patients, the underlying evidence behind these guidelines and finally review current literature which will inform future practice. This article therefore looks to reinforce best practice, to ensure that the safety and comfort of patients in the perioperative period is optimised.

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Crayon in the Orbit and Sinuses in a Pediatric Patient

Ear Nose & Throat Journal ◽

10.1177/01455613211018582 ◽

2021 ◽

pp. 014556132110185

Author(s):

Michela Borrelli ◽

Kristen A. Echanique ◽

Jeffrey Koempel ◽

Elisabeth H. Ference

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Pediatric Patient ◽

Cerebrospinal Fluid Leak ◽

Ethmoid Sinus ◽

Rare Occurrence ◽

Lamina Papyracea ◽

The Right ◽

Fluid Leak ◽

Type Of Injury

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.

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