Preoperative fasting in children undergoing elective paediatric surgery

Abstract

BACKGROUND: Preoperative fasting is important to prevent pulmonary aspiration of gastric contents. Prolonged fasting can have negative metabolic effects which are more pronounced in children. The most recent guidelines recommend preoperative fasting intervals of 6 hours for solid food; 4 hours for formula and non-human milk; 3 hours for breast milk and 1 hour for clear fluids.

This audit assessed local preoperative fasting times amongst the paediatric population undergoing elective surgery within Mater Dei Hospital.

METHODS: 113 children under the age of 16 years and who underwent elective surgery within Mater Dei Hospital were enrolled in this audit. The time the child last ate and drank, the time surgery started and duration of surgery were noted from medical records. Results were then anonymised and analysed using a Microsoft Excel ® Spreadsheet.

RESULTS: Fasting times ranged from 3 to 20.1 hours with a median of 11.8 hours and a mean fasting time of 11.3 hours. Most surgeries were planned for the morning and typically the child would start to fast at between 20:00 and 22:00. However, even in surgeries planned for the afternoon, the child still tended to skip breakfast.

CONCLUSION: This audit highlights the need for increased local awareness about paediatric preoperative fasting guidelines. Initiatives should be directed towards children, relatives and health care workers to optimise the preoperative experience for the child.