Review

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A review of pediatric fasting guidelines and strategies to help children manage preoperative fasting

Pediatric Anesthesia

September 2023 by Dr David Pachter

Summary:
Balancing the risk between pulmonary aspiration of gastric contents, and the adverse consequences of prolonged fasting times is one of the age-old conundrums of paediatric anaesthesia. This article summarises some of the recent updates in fasting guidelines that have been published by various anaesthesia societies around the world.

The general trend has been an adoption of more liberal strategies towards clear fluid consumption prior to theatre, notably a widely adopted reduction from 2 hours to 1 hour for clear fluid consumption prior to theatre. More recently, further liberalisation of fasting strategies to allow sips of clear fluids right up until the child is brought to theatre, so called “sips until send", or "6-4-0” have been introduced in centres in Europe, a point only briefly alluded in this review. The harms associated with prolonged fasting times, both psychological (eg distress resulting from thirst and hunger) and physiological (eg glycaemic and haemodynamic disturbance) are considered in detail by the authors. The final section of the article focuses on strategies aimed at improving tolerance of fasting, including the use of carbohydrate drinks and chewing gum to increase satiety, areas in which the evidence in paediatric populations is limited.

Take home messages:
In recent times there has been a trend towards strategies aimed at reducing perioperative fasting times. Reasons for this include
• The incidence of significant morbidity in children due to pulmonary aspiration is extremely low
• Excessive fasting remains common, and is associated with significant levels of distress and physiological derangement

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