Duration Of Preoperative Fasting Research Articles

Ultrasound Assessment of Prevalence of ‘At Risk Stomach’ in Children Undergoing Elective Surgery- Prospective, Observational Study

Children may be at increased risk of pulmonary aspiration because of retention of gastric contents caused by pain or inadequate fasting. We performed this study to analyze the use of ultrasound for evaluation of gastric ultrasound in children less than 12 years. Two hundred children, 1-12 years of age belonging to ASA physical status I to II, scheduled to undergo elective surgery were included in the study. Patients were scanned in supine position followed by right lateral decubitus position (RLD). In qualitative assessment, the antrum was judged to contain fluid if it appeared to have an endocavitary lumen with hypoechoic content and distended walls. All measurements were taken with antrum at rest (between contraction) to avoid underestimating volume. It was observed that majority of the children were in Perlas grade 0, 116(58%) followed by 75 children in grade 1 and 9 children in grade 2. Using Karl Pearson’s Correlation coefficient, low positive correlation was found between gastric volume and fasting status solid (in hours) and the variation (correlation) was found to be statistically non-significant (r=0.139; p>0.05). There is no proportionate decline in gastric volume with increased duration of preoperative fasting. Ultrasonographic measurement of antral area can be of interest to anesthesiologist for accurate qualitative and quantitative estimation of preoperative gastric contents and volume. However, gastric ultrasonography has to be validated in further trials involving a larger patient population before it can become a routine standard of care in perioperative period.

Preoperative clear fluids fasting times in children: retrospective analysis of actual times and complications after the implementation of 1-h clear fasting

BackgroundPreoperative fasting before elective pediatric surgery is a matter of ongoing debate. The objectives of this study were to evaluate the compliance to a recently implemented preoperative fasting protocol (clear fluids until 1 hour from the induction of anesthesia), to identify predictors of prolonged preoperative fasting time, and to determine whether duration of preoperative fasting was associated with adverse outcomes.MethodsRetrospective single-center study in an operating theater of a tertiary pediatric hospital.ResultsIn a 6-month period, 1820 consecutive patients were analyzed. The data collected in the questionnaire reporting the time of last food, milk and/or liquid intake, and eventual reasons for nonadherence was analyzed. Median (interquartile range) preoperative fasting time was 186 (110–345) min. In 502 patients (27.6%), duration of preoperative fasting to clear fluid ranged from 60 to 119 min, whereas in 616 (34%) it was 120–240 min. The reasons for not respecting fasting time rules are mostly related to communication issues or unwillingness by the patients. A significant difference in fasting times was evident between infants and children older than 10 years (188, 105–290 vs. 198, 115–362; p = 0.02). Fasting times were significantly shorter in the inpatient group and in the first scheduled patients of the morning. Clear fluids fasting times were significantly longer in patients with hypovolemia complications than in those without, 373 (185–685) vs. 180 (110–330) min (p < 0.0001). Longer fasting times to clear fluids, younger age, and scheduled surgery time were independently associated with the odds of experiencing complications.ConclusionsIn this single pediatric center study, median clear fluids fasting time was three times higher (180 min) than those recommended by the preoperative fasting protocol. Compliance to the protocol was observed in approximately 1 out of 4 patients (27.6%). Longer fasting times were associated with an increased risk of complications, which might be due to dehydration and/or hypovolemia.

The Correlation Between Pre-Operative Fasting Duration and Post-Operative Nausea and Vomiting Occurrence on Patients with General Anestehesia

Background: Preoperative fasting is a procedural measure implemented before surgery or anesthesia to avert regurgitation or vomiting. PONV incidence is influenced by surgical, anesthetic, and patient-related factors. The purpose of the study is to ascertain the duration of preoperative fasting observed by participants and the prevalence of PONV according to personality traits. Purpose: Determine the correlation between the duration of preoperative fasting and the occurrence of PONV in patients undergoing general anesthesia at RSUD Dr. Soekardjo Tasikmalaya. Methods: Observatory, descriptive, and cross-sectional designs are utilized. The sampling method was with sixty respondents ranging in age from seventeen to forty-five years, ASA I to II. Data is collected via observation and evaluation. Findings: The study observed that among 37 individuals (61.7%), preoperative fasting for 6-8 hours was beneficial, while for 23 individuals (38.3%), fasting for &gt;8 hours were detrimental. At the age of 17-25 years, 10 individuals (47.6%) develop PONV, while 11 individuals (52.4%) do so between the ages of 26-45. Among women, 17 individuals (81.0%) have PONV, while 20 individuals (95.2%) have ASA I physical status, and 1 individual (4.8%) has ASA II physical status. Conclusion: There is a significant link (p &lt; 0.013) between preoperative fasting time and postoperative nausea and vomiting (PONV) in patients under general anesthesia. Fasting before surgery should be long enough to avoid PONV

The actual duration of preoperative fasting in pediatric patients, and its effects on hunger and thirst: a prospective observational study.

Preoperative fasting time for food and clear liquid was recommended as 2 and 6 h to prevent pulmonary aspiration. Prolonged fasting led to ketosis, hypotension, and patient discomfort. This study aimed to investigate the actual duration of preoperative fasting in pediatric patients, its effects on hunger and thirst, and factors that influence hunger and thirst. This prospective observational study recruited participants aged 0-15 years who were scheduled for elective surgery or for other procedures to be performed under general anesthesia in a tertiary care center. All parents or participants were asked to report the fasting time for food and clear liquid. Participants aged 7-15 years self-rated their degree of hunger and thirst using a 0-10 scale. For participants aged less than 7 years, parents were asked to rate their child's degree of hunger based on the child's behavior. Dextrose-containing intravenous fluid administration and anesthesia start time were collected. Three hundred and nine participants were included. The overall median [interquartile range; IQR] fasting duration for food and clear liquid was 11.1 h [IQR: 8.0, 14.0] and 10.0 h [IQR: 7.2, 12.5], respectively. The overall median hunger and thirst score was 7 [IQR: 5, 9] and 5 [IQR: 0, 7.5], respectively. High hunger score was reported in 76.4% of participants. There was no correlation between fasting time for food and hunger score [Spearman's rank correlation coefficient (Rho): -0.150, P=0.008], or between fasting time for clear liquid and thirst score (Rho: 0.007, P=0.955). Zero to 2-year-old participants had a significantly higher hunger score compared to older participants (P<0.001) and a higher proportion (80-90%) of high hunger score regardless of anesthesia start time. Although dextrose-containing fluid was administered ≥10 mL/kg, 85.7% of this group still reported high hunger score (P=0.008). Ninety percent of participants who had anesthesia start time after 12:00 PM reported high hunger score (P=0.044). The actual duration of preoperative fasting was found to be longer than the recommendation for both food and liquid in pediatric surgical population. Younger age group and anesthesia start time in the afternoon were factors associated with high hunger score.

PREOPERATIVE FASTING AMOUNTING TO DEHYDRATION IN PEDIATRICS AGE GROUP- AN OBSERVATIONAL STUDY

Introduction: Pre-preoperative fasting, a universally practiced principle in elective cases helps to reduce the risk of pulmonary aspiration of gastric contents. Prolonged fasting for 8-10 hours has been practiced at various places to avoid complications like Mendelson's Syndrome and Aspiration Pneumonia. However, prolonged fasting may be an unpleasant experience causing distress, irritability, dehydration and hypoglycemia especially in pediatric patients. Studies have reported many children end up fasting for up to 12 or 15 hours inspite of recommended 6-4-2 guidelines, leading to side-effects like, hypoglycemia, metabolic acidosis, dehydration.In this study, we tried to acertain the dehydration status due to various reasons and also suggested a solution for the same. To assess the Aims dehydration status of pediatric patient based on clinical dehydration scale. (1) T Objectives: o asses the complaints of paient suggesting dehydration on well designed proforma.(2) To asses amount of dehydartion according to dryness of mucous membranes by using nger print impression This randomised trial was conducted on 100 NBM paediatric patients Materials And Methods: in age group of 0-14 yrs at Dr. D.Y.Patil Medical College ,Pune. Time at which the patient was wheeled into operation theater, duration of preoperative fasting was noted ,calculated, analyzed and compared. The tongue was assessed to nd the degree of hydration with help of nger impression from moist tongue on parchment paper and scoring was given as follows: Scoring:5- almost full nger impression,3- half nger impression and 1-No nger impression. The nger impression test was, No impression (score=1) in 40 patient Result: s, half nger impression (score=3) in 37 patients and almost full nger impression (score =5) in 23 patients. Fasting time for pe Conclusion: diatric patients in our study were typically far longer than current guidelines. This can be attributed to surgery timings of previous patients inside the theatre leading to prolonged fasting time.

Effect of multidisciplinary interventions in perioperative management center on duration of preoperative fasting: A single-center before-and-after study.

Our aims were to clarify the actual situation regarding preoperative fasting and determine whether multidisciplinary interventions in a perioperative management center shorten the duration of preoperative fasting. The cohort of this before-and-after study comprised patients undergoing elective surgery aged 18 years or older who underwent general anesthesia at one of three stages: after starting a short preoperative fasting protocol (Group A), after the anesthesiologist started explaining the protocol (Group B), and after the start of the perioperative management center (Group C). Instructions on drinking clear fluids were given up to 2h and 4h before the start of elective surgery to the first patient on the list (on-time) and to the second and subsequent patients (on-call), respectively. Data were collected retrospectively in Groups A and B and prospectively in Group C. The study cohort comprised 89 patients in Group A (50 on-time, 39 on-call), 108 in Group B (65 on-time, 43 on-call), and 284 in Group C (182 on-time, 102 on-call). The difference between the instructed and last drinking time was significantly shorter in Group C than Group A (30 [10, 140] vs. 30 [10, 60] vs. 20 [0, 50] min, p=0.003). The duration of fasting was significantly shorter in Group C than Group B (243 [150, 395] vs. 213 [151, 323] vs. 180 [146, 280] min, p=0.01). Multidisciplinary interventions at the perioperative management center tended to reduce the duration of fasting, suggesting that this approach may contribute to improved compliance.

Recording and evaluating the adherence of preoperative fasting guidelines

Rationale: Preoperative fasting aims at prevention of aspiration during anaesthesia induction. Prolonged fasting deteriorates patient’s metabolic state and reduces patient comfort. Although the duration of preoperative fasting is clearly described, adherence to the guidelines seems poor. This study assessed preoperative fasting guideline compliance for electively scheduled surgical patients.

Preoperative Fasting Times for Patients Undergoing Elective Surgery at a Pediatric Hospital in Shanghai: The Big Evidence-Practice Gap

PurposePreoperative fasting is a necessary experience for pediatric patients undergoing elective surgery. The American Society of Anesthesiologist guideline shows that preoperative fasting times were reduced and safe (no solid food up to 8 hours, no fluid or formula up to 6 hours, no breast milk up to 4 hours, and no clear fluids up to 2 hours before surgery). However, preoperative fasting is usually more prolonged than the suggested time. This study aimed to investigate the duration of preoperative fasting for elective surgery at a pediatric hospital in Shanghai, China, and compare it with the evidence from guidelines. DesignThe study used a descriptive cross-sectional design. MethodsA total of 211 children under anesthesia in a Shanghai's pediatric hospital were included in the study. The preoperative fasting status was assessed using a self-administered record card of preoperative fasting developed by Chinese researchers. FindingsThe results indicated that the length of time fasted preoperatively was longer for all participants than that recommended by the American Society of Anesthesiologists. With the long length of fasting time, it is evident that the majority of children experienced hunger (17.5%), thirst (19.4%), and anxiety (16.1%) as indicated with 8 points of the Likert 10-point scale. The degrees of these experiences were relevant to the length of preoperative fasting time. ConclusionsA big gap was revealed between the recommendation and actual practice, and children underwent an uncomfortable experience before the surgery. These results suggest that evidence-based clinical improvement is required, and the recommended preoperative fasting instruction transform into clinical practice should be promoted.

The effect of preoperative fasting to postoperative agitation, nausea, and vomiting in children with tonsillectomy

Objective: This study was conducted to investigate the effect of preoperative fasting period on postoperative agitation, nause and vomiting in children with tonsillectomy.&#x0D; Material and Methods: Children (n:123) who have had tonsillectomy between June and December 2017 and their families have taken place in the study. The data were collected by the researchers with a questionnaire. The data were analyzed using the SPSS 18 package program and with descriptive, Mann Whitney U test, Spearman Correlation test.&#x0D; Results: The mean duration of preoperative fasting was 11.03±1.17 hours, the duration of thirst was 10.17±1.00 hours. The mean behavior scores of the children were 1.28±0.27 points, the mean vomiting score of the children was 0.01±0.07 points, 56.9% of the children in the postoperative unit were not experiencing nausea. Between duration of preoperative fasting with agitation and vomiting status in postoperative unit was found to statistically no relationship. According to preoperative fasting time of children, a statistically significant difference was found when children were diagnosed as having or not having symptoms of nausea.&#x0D; Conclusıon: It was found that the children had longer duration of preoperative fasting than the guidelines suggested in the guidelines. It was observed that pre-operative fasting time did not affect postoperative agitation and vomiting, but it affected nausea.&#x0D; Practice Implications: Surgical nurses should emphasize the importance of fasting period to families before surgery and inform families on this issue.&#x0D;

Fasting habits over a 10-year period: An observational study on adherence to preoperative fasting and postoperative restoration of oral intake in 2 Dutch hospitals

BackgroundSince 1999, international guidelines recommend fasting from solid foods up to 6 hours and clear liquids up to 2 hours before surgery. Early recovery after surgery programs recommend restoration of oral intake as soon as possible. This study determines adherence to these guidelines up to 20 years after its introduction. MethodsA 2-center observational study with a 10-year interval was performed in the Netherlands. In period 1 (2009), preoperative fasting time was observed as primary outcome. In period 2 (2019), preoperative fasting and postoperative restoration of oral intake were observed. Fasting times were collected using an interview-assisted questionnaire. ResultsDuring both periods, 311 patients were included from vascular, trauma, orthopedic, urological, oncological, gastrointestinal, and ear-nose-throat and maxillary surgical units.Duration of preoperative fasting was prolonged in 290 (90.3%) patients for solid foods and in 208 (67.8%) patients for clear liquids. Median duration of preoperative fasting from solid foods and clear liquids was respectively 2.5 and 3 times the recommended 6 and 2 hours, with no improvements from one period to another. Postoperative food intake was resumed within 4 hours in 30.7% of the patients. Median duration of perioperative fasting was 23:46 hours (interquartile range 20:00–30:30 hours) for solid foods and 11:00 hours (interquartile range 7:53–16:00 hours) for clear liquids. ConclusionOld habits die hard. Despite 20 years of fasting guidelines, surgical patients are still exposed erroneously to prolonged fasting in 2 hospitals. Patients should be encouraged to eat and drink until 6 and 2 hours, respectively, before surgery and to restart eating after surgery.

The Effects of Preoperative Fasting on Patients Undergoing Thoracic Surgery

PurposeThe purpose of this study was to determine the effects of fasting before surgery on patients undergoing thoracic surgery. DesignThis descriptive cross-sectional study was conducted from January 1 to June 30, 2017. MethodsThe study was carried out with 85 patients who underwent thoracotomy, mediastinoscopy, or rib resection in the thoracic surgery department of a university hospital. All patients started fasting midnight before day of surgery. Data were collected using a questionnaire, Visual Analog Patient Satisfaction Scale, and preoperative laboratory findings form. FindingsThe mean fasting hours of solids and clear fluids were 8 and 16, respectively, and the mean duration of preoperative fasting (POF) was 10.16 (SD = 1.67), total fasting time average was 28.09 (SD = 7.11). Total protein and albumin levels decreased, and glucose level increased after surgery. The difference between total protein, albumin, and glucose levels preoperatively and postoperatively was significant (P < .05). The difference between patient satisfaction and thirst was found to be statistically significant (P < .05). A positive correlation was found between POF and thirst (r = 0.450; P = .000), hunger (r = 0.402; P = .000), total protein (r = 0.508; P = .000), albumin (r = 0.537; P = .000), and glucose levels (r = 0.371; P = .000). ConclusionsPOF had an adverse effect on thirst, hunger, and total protein as well as albumin and glucose levels.

A prospective study of paediatric preoperative fasting times at Red Cross War Memorial Children's Hospital, Cape Town, South Africa.

Fasting for liquids and solids is recommended prior to procedures requiring anaesthesia, to reduce the risk of pulmonary aspiration. Children often experience excessive fasting, which is associated with negative physiological and behavioural consequences, and patient discomfort. The duration of preoperative fasting in children in South Africa (SA) is unknown. To determine compliance with fasting guidelines and fasting times of children prior to elective procedures performed under anaesthesia at a paediatric hospital in Cape Town, SA. The primary focus was fasting for clear liquid. We also intended to identify the most common reasons for prolonged clear liquid fasting. Over a 7-week period, we prospectively captured fasting times of consecutive patients undergoing elective surgical, medical and radiological procedures at Red Cross War Memorial Children's Hospital. Measurement outcomes were defined as the period from the last clear liquid, milk or solid feed to the start of anaesthesia. For analysis of compliance with preoperative fasting guidelines, institutional preoperative fasting target limits were established based on the standard 6-4-2-hour guideline. The study included 721 elective paediatric cases. The mean (standard deviation (SD)) fasting time for clear liquids (n=585) was 8.0 (4.8) hours, with an adherence rate of 25.5% (95% confidence interval 22 - 29) to the institutional target of 2 - 4 hours. The mean (SD) fasting times for breastmilk (n=92), formula milk (n=116) and solid feeds (n=560) were 7.1 (2.8), 8.8 (2.8) and 13.9 (3.6) hours, respectively. The factors associated with clear liquid fasting &gt;4 hours were inadequate fasting instructions, poor adherence to fasting orders, procedural delays and fasting to promote theatre flexibility. This study demonstrates that children in an SA hospital experience excessive fasting times prior to elective procedures. To reduce fasting durations and improve the quality of perioperative care, quality improvement interventions are required to create an adaptable fasting system that allows individualised fasting. Improving preoperative fasting times in children is the responsibility of all healthcare professionals in the multidisciplinary management team.

Fasting and surgery timing (FaST) audit

SummaryBackground & aimsInternational guidance advocates the avoidance of prolonged preoperative fasting due to its negative impact on perioperative hydration. This study aimed to assess the adherence to these guidelines for fasting in patients undergoing elective and emergency surgery in the East Midlands region of the UK.MethodsThis prospective audit was performed over a two-month period at five National Health Service (NHS) Trusts across the East Midlands region of the UK. Demographic data, admission and operative details, and length of preoperative fasting were collected on adult patients listed for emergency and elective surgery.ResultsOf the 343 surgical patients included within the study, 50% (n = 172) were male, 78% (n = 266) had elective surgery and 22% (n = 77) underwent emergency surgery. Overall median fasting times (Q1, Q3) were 16.1 (13.0, 19.4) hours for food and 5.8 (3.5, 10.7) hours for clear fluids. Prolonged fasting >12 h was documented in 73% (n = 250) for food, and 21% (n = 71) for clear fluids. Median fasting times from clear fluids and food were longer in the those undergoing emergency surgery when compared with those undergoing elective surgery: 13.0 (6.4, 22.6) vs. 4.9 (3.3, 7.8) hours, and 22.0 (14.0, 37.4) vs. 15.6 (12.9, 17.8) hours respectively, p < 0.0001.ConclusionsDespite international consensus on the duration of preoperative fasting, patients continue to fast from clear fluids and food for prolonged lengths of time. Patients admitted for emergency surgery were more likely to fast for longer than those having elective surgery.

Results of a survey on peri-operative nutritional support in pancreatic and biliary surgery in Spain.

Introduction: a survey on peri-operative nutritional support in pancreatic and biliary surgery among Spanish hospitals in 2007 showed that few surgical groups followed the 2006 ESPEN guidelines. Ten years later we sent a questionnaire to check the current situation. Methods: a questionnaire with 21 items sent to 38 centers, related to fasting time before and after surgery, nutritional screening use and type, time and type of peri-operative nutritional support, and number of procedures. Results: thirty-four institutions responded. The median number of pancreatic resections (head/total) was 29.5 (95% CI: 23.0-35; range, 5-68) (total, 1002); of surgeries for biliary malignancies (non-pancreatic), 9.8 (95% CI: 7.3-12.4; range, 2-30); and of main biliary resections for benign conditions, 10.4 (95% CI: 7.6-13.3; range, 2-33). Before surgery, only 41.2% of the sites used nutritional support (< 50% used any nutritional screening procedure). The mean duration of preoperative fasting for solid foods was 9.3 h (range, 6-24 h); it was 6.6 h for liquids (range, 2-12). Following pancreatic surgery, 29.4% tried to use early oral feeding, but 88.2% of the surveyed teams used some nutritional support; 26.5% of respondents used TPN in 100% of cases. Different percentages of TPN and EN were used in the other centers. In malignant biliary surgery, 22.6% used TPN always, and EN in 19.3% of cases. Conclusions: TPN is the commonest nutrition approach after pancreatic head surgery. Only 29.4% of the units used early oral feeding, and 32.3% used EN; 22.6% used TPN regularly after surgery for malignant biliary tumours. The 2006 ESPEN guideline recommendations are not regularly followed 12 years after their publication in our country.

Quality improvement project to reduce pediatric clear liquid fasting times prior to anesthesia.

Unnecessarily long preprocedural fasting can cause suffering and distress for children and their families. Institutional fasting policies are designed to consistently achieve minimum fasting times, often without regard to the extent to which actual fasting times exceed these minimums. Children at our hospital frequently experienced clear liquid fasting times far in excess of required minimums. The aim of this study was toutilize quality improvement methodology to reduce excess fasting times, with a goal of achieving experienced clear liquid fasting times ≤4hours for 60% of our patients. This quality improvement project was conducted between July 2017 and August 2018. A multidisciplinary team performed a series of Plan-Do-Study-Act cycles focused on children undergoing elective procedures at a large children's hospital. Key drivers for clear liquid fasting times and relevant balancing measures were identified. Data were analyzed using control charts and statistical process control methods. Approximately 16000 children were involved in this project. Over the course of the project, the percentage of children with goal clear liquid fasting times improved from the baseline of 20%-63%, with a change in the mean fasting time from 9hours to 6hours. There were no significant effects on balancing measures (case delays/cancellations and clinically significant aspiration events). Using quality improvement methodology, we safely improved the duration of preoperative fasting experienced by our patients. Our results provide additional data supporting the safety of more permissive 1-hour clear liquid fasting minimums. We suggest other institutions pursue similar efforts to improve patient and family experience.

FACTORS RELATED TO THE REDUCTION OF THE RISK OF COMPLICATIONS IN COLORECTAL SURGERY WITHIN PERIOPERATIVE CARE RECOMMENDED BY THE ACERTO PROTOCOL.

ABSTRACTBackground:Perioperative care multimodal protocol significantly improve outcome in surgery. Aim:To investigate risk factors to various endpoints in patients submitted to elective colorectal operations under the ACERTO protocol. Methods:Cohort study analyzing through a logistic regression model able to assess independent risk factors for morbidity and mortality, patients submitted to elective open colon and/or rectum resection and primary anastomosis who were either exposed or non-exposed to demographic, clinical, and ACERTO interventions. Results:Two hundred thirty four patients were analyzed and submitted to 156 (66.7%) rectal and 78 (33.3%) colonic procedures. The length of hospital postoperative stay (LOS) ≥ 7 days was related to rectal surgery and high NNIS risk index; preoperative fasting ≤4 h (OR=0.250; CI95=0.114-0.551) and intravenous volume of crystalloid infused > 30ml/kg/day (OR=0.290; CI95=0.119-0.706). The risk of postoperative site infection (SSI) was approximately four times greater in malnourished; eight in rectal surgery and four in high NNIS index. The duration of preoperative fasting ≤4 h was a protective factor by reducing by 81.3% the risk of surgical site infection (SSI). An increased risk for anastomotic fistula was found in malnutrition, rectal surgery and high NNIS index. Conversely, preoperative fasting ≤4 h (OR=0.11; CI95=0.05-0.25; p<0.0001) decreased the risk of fistula. Factors associated with pneumonia-atelectasis were cancer and rectal surgery, while preoperative fasting ≤ 4 h (OR=0.10; CI95=0.04-0.24; p<0.0001) and intravenous crystalloid ≤ 30 ml/kg/day (OR=0.36; CI95=0.13-0.97, p=0.044) shown to decrease the risk. Mortality was lower with preoperative fasting ≤4 h and intravenous crystalloids infused ≤30 ml/kg/day. Conclusion:This study allows to conclude that rectal procedures, high NNIS index, preoperative fasting higher than 4 h and intravenous fluids greater than 30 ml/kg/day during the first 48 h after surgery are independent risk factors for: 1) prolonged LOS; 2) surgical site infection and anastomotic fistula associated with malnutrition; 3) postoperative pneumonia-atelectasis; and 4) postoperative mortality.

Correlation between duration of preoperative fasting and emergence delirium in pediatric patients undergoing ophthalmic examination under anesthesia: A prospective observational study.

Preoperative fasting in children can cause anxiety, which may ultimately lead to postoperative emergence delirium. However, no data are available whether duration of preoperative fasting correlates with postoperative emergence delirium. The aim of this study was to identify if there is any correlation between the duration of preoperative fasting and emergence delirium in children undergoing ophthalmic examination under anesthesia. In this prospective observational study, 100 children between the age group 2-6years of American Society of Anesthesiologists physical status I or II, scheduled for examination of the eye under general anesthesia with sevoflurane were recruited. Data regarding preoperative fasting was recorded and presence of emergence delirium was assessed by the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5minute interval till 30minutes from the time of leaving the operation theater. No premedication was used in any patients but parental presence was allowed in all of them. Mean (standard deviation) duration of fasting to clear liquid was 6.3 (1.7) hrs. Twenty-four children (24%) had at least 1 recorded PAED score >10 at any time point in the postoperative period. PAED scores at 15 and 25minutes were significantly correlated with duration of fasting (r2 [95% CI]=.24 [0.04, 0.41], P=.02, Pearsons's correlation and r2 [95% CI]=.23 [0.04, 0.41], P=.02, Pearsons's correlation, respectively). No correlation has been found between duration of fasting and blood glucose level (r2 [95% CI]=-.05 [-0.24, 0.15], P=.65, Pearsons's correlation) between fasting blood glucose and PAED score at any time point. Increased preoperative fasting duration may be a risk factor for postoperative emergence delirium in children undergoing ophthalmic examination under general anesthesia.

Improvement in the duration of pre-operative fasting in children

Introduction: Source of discomfort and dissatisfaction, the rules of pre-operative fasting have evolved a lot in recent years. Objective: To evaluate the duration of preoperative fasting in children and the degree of parental support for this strategy. Materials and Methods: Prospective mono-centric study on the implementation of a preoperative fasting strategy in children. Pediatric surgery department of the Teaching University Hospital (TUH) of Sidi-Bel-Abbès over a period of three years from July 2015 to June 2018. Included were all children from 6 months-15 years, who are asked the indication of anesthesia for minor surgery. We gathered the respect and understanding of the parents of preoperative fasting. Results: One thousand three children were included in the study, the mean age was: 62.01 ± 44.14 months, the sex ratio was 3.6/1 with male predominance. The majority of children were under six years old. The socio-cultural level of parents was medium to high in 88.4% of cases. The mean duration of preoperative fasting was 6.9 ± 4.16 hours and ranged from 2 hours to more than 11 hours. Almost 70% of children had a six-hour fast during the second year. Discussion: In our work, the vast majority of parents respected the pre-op fasting of their children. The improvement in the duration of preoperative fasting was done through a follow-up protocol by the entire pediatric surgery team. The application of the rules of fasting by parents must be strict and simple.

Audit on preoperative fasting of elective surgical patients in an African academic medical center.

Background Preoperative fasting is a requisite before anesthesia. The main reason for preoperative fasting is to reduce gastric volume and acidity and thus decrease the risk of pulmonary aspiration. However, preoperative fasting is usually prolonged beyond the recommended time for various reasons. Despite the many adverse effects of prolonged fasting, patients sometimes fasted for a prolonged time when surgery was delayed for different reasons at the University of Gondar Hospital. The aim of this study was to assess the duration of preoperative fasting for elective surgery.MethodsA cross-sectional study was conducted from March 10 to April 10, 2013. Patients were interviewed 24 h after surgery. All 43 patients who were under anesthesia while operated on during the study period were included.Result Of the 43 patients included in the study, 35 were adults and 8 were children. The minimum, maximum, and mean fasting hours for food were 5, 96, and 19.60, respectively, and more than 50 % of the patients fasted from food twice as long as recommended. The minimum, maximum, and mean fasting hours for fluid were 5, 19, and 12.72, respectively. More than 95 % of the patients fasted from fluid longer than recommended.ConclusionMost patients fasted from both food (92 %) and fluid (95 %) longer than the fasting time recommended by the AAGBI, ASA, RCOA, and RCN fasting guidelines. Anesthetists, surgeons, and nurses need to revise operation lists every day in the operating theatres and resuscitate the patients when surgery is delayed for various reasons. A preoperative fasting guideline should be developed and implemented in the University of Gondar Hospital.

Preoperative fasting: current practice and areas for improvement

Preoperative fasting aims to increase patient safety by reducing the risk of adverse events during general anaesthesia. However, prolonged fasting may be associated with dehydration, hypoglycaemia and electrolyte imbalance as well as patient discomfort. We aimed to examine compliance with the current best practice guidelines in a large surgical unit and to identify areas for improvement. Adult patients undergoing elective and emergency general, orthopaedic, gynaecology and vascular surgery procedures in the Royal Infirmary of Edinburgh were surveyed over a 3-month period commencing November 2011. A standardised questionnaire was used to collect information on the duration of preoperative fasting and the advice administered by medical and nursing staff. 292 patients were included. Median fast from solids was 13.5h for elective patients (IQR 11.5-16) and 17.38h for emergency patients (IQR 13.68-28.5h). Similarly, the median fast from fluids was 9.36h for elective patients (IQR 5.38-12.75h) and 12.97h for emergency patients (IQR 8.5-16.22h). The instructions that elective patients received contributed to prolonged fasting times. The median fast for elective patients fully compliant with fasting advice would be 10h for solids (IQR 8.75-12h) and 6.25h (IQR 3.83-9.25h) for clear fluids. Elective patients fasted for longer than recommended confirming that clinical practice is slow to change. The use of universal fasting instructions and patient choice are factors that unnecessarily prolong preoperative fasting, which however appears to be multifactorial. Service improvement by abbreviation of the observed fasting periods will rely on targeted staff education and effective clinical communication by provision of written information for both elective and emergency surgical patients. The routine use of preoperative nutritional supplements may need to be re-examined when further evidence is available.