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. 2013 Jan;29(1):88-91.
doi: 10.4103/0970-9185.105810.

Preoperative fasting in children: An audit and its implications in a tertiary care hospital

B G Arun  1 , Grace Korula
Affiliations

Preoperative fasting in children: An audit and its implications in a tertiary care hospital

B G Arun et al. J Anaesthesiol Clin Pharmacol. 2013 Jan.

Abstract

Background: Prolonged preoperative fasting in children is a common problem, especially in highvolume centers. All international professional society guidelines for preoperative fasting recommend 2 h for clear fluids, 4 h for breast milk and 6 h for solids, nonhuman and formula milk in children. These guidelines are rarely adhered to in practice.

Aims: An audit was undertaken to determine the length of preoperative fasting time in children and its causes.

Settings and design: Cross-sectional study of 50 children below 15 years posted for elective surgeries.

Materials and methods: An initial audit was performed at our institution on preoperative fasting time in 50 children below 15 years of age for elective surgeries. The mean preoperative fasting times were found to be much longer than the recommended times. Ward nurses were then educated about internationally recommended preoperative fasting guidelines in children. Anesthesiologists started coordinating with surgeons and ward nurses to prescribe water for children waiting for more than 2 h based on changes in surgery schedule by instructing ward nurses through telephone on the day of surgery. A reaudit was done 6 months after the initial audit.

Statistical analysis used: SPSS 16 software.

Results: The initial audit revealed a mean preoperative fasting time of 11.25 h and 9.25 h for solids and water, respectively. Incorrect orders by ward nurses (74%) and change in the surgical schedule (32%) were important causes. After changing the preoperative system, mean preoperative fasting times in children decreased to 9 h and 4 h for solids and water, respectively in reaudit. Change in surgical schedule (30%) was the major cause for prolonged preoperative fasting in reaudit.

Conclusions: Simple steps such as education of ward nurses and better coordination among the anesthesiologists, surgeons and nurses can greatly reduce unnecessary preoperative starvation in children.

Keywords: Audit; children; fasting guidelines; preoperative fasting.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Preoperative time without food [solids and milk (breast and nonhuman)]
Figure 2
Figure 2
Preoperative time without water
Figure 3
Figure 3
Relation between case schedule and time without food
Figure 4
Figure 4
Relation between case schedule and time without water
See this image and copyright information in PMC

References

    1. Ljungqvist O, Soreide E. Preoperative fasting. Br J Surg. 2003;90:400–6. - PubMed
    1. De Aguilar-Nascimento JE, Dock-Nascimento DB. Reducing preoperative fasting time: A trend based on evidence. World J Gastrointest Surg. 2010;2:57–60. - PMC - PubMed
    1. American Society of Anesthesiologists committee on standards and practice parameters. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures.An updated report. Anesthesiology. 2011;114:495–511. - PubMed
    1. Association of Paediatric Anaesthetists of Great Britain and Ireland: APA consensus guideline on perioperative fluid management in children. 2007. [Last accessed on 2012 Jul 11]. Available from: http://www.apagbi.org.uk/sites/default/files/Perioperative_Fluid_Managem... .
    1. Royal College of Nursing. Perioperative Fasting in Adults and Children: An RCN guideline for the multidisciplinary team. 2005. [Last accessed on 2012 Jul 11]. Available from: http://www.rcn.org.uk/__data/assets/pdf_file/0009/78678/002800.pdf .