How Long a Fast Before Elective Surgery?

Abstract

Anesthesiology| November 01 2003 How Long a Fast Before Elective Surgery? AAP Grand Rounds (2003) 10 (5): 58–59. https://doi.org/10.1542/gr.10-5-58 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation How Long a Fast Before Elective Surgery?. AAP Grand Rounds November 2003; 10 (5): 58–59. https://doi.org/10.1542/gr.10-5-58 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: surgical procedures, elective, fasting, pulmonary aspiration Source: Cook-Sather SD, Harris KA, Chiavacci R, et al. A liberalized fasting guideline for formula-fed infants does not increase average gastric fluid volume before elective surgery. Anesth Analg. 2003;96:965–969. This prospective, randomized, observer-blinded trial was undertaken at the Children’s Hospital of Philadelphia to determine whether infants’ gastric fluid volume was affected by a shorter period of pre-anesthetic fast from formula. Ninety-seven infants aged less than 10 months were enrolled during a 32-month period and randomized to 2 groups. The liberalized fasting group (mean age, 5.7 months) was allowed formula 4–6 hours prior to the induction of general anesthesia but no solids or cow’s milk within 8 hours of induction. The traditional group (mean age, 6.4 months) was allowed clear liquids 2–5 hours prior to the induction of general anesthesia and no solids, milk, or formula within 8 hours of induction. All subjects were American Society of Anesthesiology (ASA) physical status I or II and scheduled for elective surgical procedures which would require endotracheal intubation. Anesthesia was induced by inhalation of oxygen and nitrous oxide with either halothane or sevoflurane. Once intubated, gastric fluid was aspirated and the volume measured. The 2 groups did not differ with regard to age, weight, gender, or volume of last feed. As expected, based on the study design, the liberalized feeding group had an average fasting time of 5.4+/−0.7 hours versus 3.8+/−0.8 hours for the traditional group (P<.0005). No subject 0005). No subject P in this study had evidence of aspiration of gastric contents. The mean gastric fluid volume (GFV) and pH were not statistically different between the 2 groups. GFV was 0.16 ml/kg in the traditional group and 0.19 ml/kg in the liberalized group. Sixty-four percent of the infants fed by the traditional method and 55% of the liberalized feeding group had a GFV of zero. GFV did not correlate with fasting interval or with the volume of the last feeding. GFV did increase slightly with age. Parents’ response to a short survey of questions about their infant’s irritability and hunger as well as the parents’ satisfaction with the perioperative fasting period did not differ between the liberalized and traditional fasting groups. The authors note that their study was too small to demonstrate a change in the incidence of perioperative aspiration resulting from a change in fasting practice. A 0.01% incidence of pulmonary aspiration related to the induction of general anesthesia in pediatrics has been reported at a university-affiliated hospital.1 In another review of 56,000 patients younger than 18 years of age, an overall incidence of pulmonary aspiration of 0.04% was reported.2 It was noted in that review that the frequency of pulmonary aspiration did not differ across different age groups or ASA physical status classification.2 Pre-anesthesia fasting intervals reflect the tension between minimizing the risk of gastric content aspiration and assuring adequate hydration and patient comfort during the period of fasting. Fasting guidelines for infants and children have been modified frequently over... You do not currently have access to this content.