“Prolonged fasting in paediatric anaesthesia: still a challenge in our practice? – an audit study”
“Prolonged fasting: a pediatric anaesthesia challenge?”
DOI:
https://doi.org/10.25751/rspa.26147Keywords:
Clinical Audit, Fasting, Preoperative Care, Quality ImprovementAbstract
Introduction: Preoperative fasting has been reviewed constantly. Its main goal is avoiding pulmonary aspiration of gastric contents during anaesthesia. When performed for an excessive period, which is frequently verified, it is associated with adverse events. The present study audits the fasting time in elective paediatric surgery at our institution.
Material and methods: We prospectively audited the fasting duration of all children undergo for elective surgery by the Paediatric Surgery team between 26 March 2021 and 26 April 2021. It was recorded fasting duration for clear fluids, breast milk and solids/formula milk.
Results: 53 patients were included, from 1 month to 18 years. All were classified as American Society of Anaesthesiologists physical status I. The average to fasting time was 9,33,3 hours for clear fluids and 9,83,0 hours for solids/formula milk. More than 50% of patients have at least 10h of fasting time for clears fluids.
Discussion: In our Institution, paediatric patients fasted much longer than recommended before anaesthesia for elective surgery, possibly related to the trend of ordering nothing per mouth overnight or after midnight, the lack of local protocols, non-disclosure of the worst outcomes underlying prolonged fasting regimens, absence of pre-anaesthetic consultation and possible lack of update to the most recent recommendations.
Conclusions: Prolonged fasting times are still a problem in today's reality. Measures are needed to promote its reduction, in accordance with current guidelines. We believe that a contact the day before surgery and the implementation of a multidisciplinary training program can be part of the solution.
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Copyright (c) 2023 Carolina Romano Ribeiro, Mafalda Martins, Cláudia Dourado, Daniela Pinho
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