Preoperative Fasting in Children

Mesbah A and Thomas M

There is increasing recognition that a prolonged preoperative fast is not desirable let alone advantageous.

Gastric physiology is under a complex set of control factors that combine to ensure a steady release of nutrients to the small bowel and beyond. Gastric emptying is regulated by hormonal, neuronal, and metabolic feedback.

For clear fluid, there is good evidence in children that emptying can occur well within the advocated 2 h guidelines.

Perioperative pulmonary aspiration in children is rare. The incidence is 0.07–0.1% and the consequences of clear fluid aspiration are not catastrophic. Even when a rare clear fluid aspiration occurs, the consequences do not appear to be severe or long term.

More liberal clear fluid regimens for elective cases seem to confer no increased risk of aspiration without subjecting large numbers of children and carers to the distress of a prolonged fast. Further the most recent consensus statement on clear fluids by RCOA allows a 6-4-1 (solids-6h, breast milk-4h, clear fluids-1h) rule unless contraindicated.

Discussion in the Journal Club

Children are fasted for more than 6 hrs for elective surgeries, nevertheless they seldom receive clear fluids up to 2 hrs prior to surgery, as parents are worried about aspiration risk. However, providing pre operative carbohydrated drinks an hour prior to elective surgery in the hospital would help reduce metabolic effects of fasting and surgery.

We are planning in the department to introduce a “Welcome Drink” for paediatric patients on arrival to the hospital for their operation, with the exception of the first patient on the list, to decrease the length of fluid fasting in our patients.

Summary by Dr S Eswarappa. Journal Club Meeting 28 June 2018.