Christiane E Beck1, Diana Rudolp2, Karin Becke-Jakob3, Ehrenfried Schindler4, Alexander Etspüler5, Almut Trapp6, Gordon Fink7, Lutz Müller-Lobeck8, Katharina Röher9, Arka Genähr10, Christoph Eich2, Robert Sümpelmann1. 1. Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany. 2. Department of Anesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany. 3. Department of Anesthesia, Cnopf'sches Children's Hospital, Nürnberg, Germany. 4. Department of Anesthesia, Asklepios Children's Hospital, St. Augustin, Germany. 5. Department of Anesthesia, Altona Children's Hospital, Hamburg, Germany. 6. Department of Anesthesia, Intensive Care Medicine, Pain Medicine and Palliative Care Medicine, Sana Clinic Leipziger Land, Borna, Germany. 7. Department of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Vivantes Hospital im Friedrichshain, Berlin, Germany. 8. Clinic of Anesthesiology and Intensive Care Medicine, Lippe Hospital, Detmold, Germany. 9. Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 10. Department of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Vivantes Hospital Neukölln, Berlin, Germany.
Abstract
BACKGROUND: Prolonged fasting before anesthesia is still common in children. Shortened fasting times may improve the metabolic and hemodynamic condition during induction of anesthesia and the perioperative experience for parents and children and simplify perioperative management. As a consequence, some centers in Germany have reduced fasting requirements, but the national guidelines are still unchanged. AIMS: This prospective multicenter observational study was initiated by the Scientific Working Group for Pediatric Anesthesia of the German Society of Anesthesiology and Intensive Care Medicine to evaluate real fasting times and the incidence of pulmonary aspiration before a possible revision of national fasting guidelines. METHODS: After the Ethics Committee's approval, at least 3000 children were planned to be enrolled for this analysis. Patient demographics, real fasting times, anesthetic and surgical procedures and occurrence of regurgitation or pulmonary aspiration were documented using a standardized case report form. Results were presented as median [interquartile range] (range) or incidence (percentage). RESULTS: At ten pediatric centers, 3324 children were included between October 2018 and May 2019. The real fasting times for large meals were 14 [12.2-15.6] (0.5-24) hours, for light meals 9 [5.6-13.3] (0.25-28.3) hours, for formula milk 5.8 [4.5-7.4] (0.9-24) hours, for breast milk 4.8 [4.2-6.3] (1.3-25.3) hours and for clear fluids 2.7 [1.5-6] (0.03-22.8) hours. Prolonged fasting (deviation from guideline >2 hours) was reported for large meals in 88.3%, for light meals in 54.7%, for formula milk in 44.4%, for breast milk in 25.8% and for clear fluids in 34.2%. Eleven cases (0.33%) of regurgitation, four cases (0.12%) of suspected pulmonary aspiration and two cases (0.06%) of confirmed pulmonary aspiration were reported; all of them could be extubated after the end of the procedure and recovered without any incidents. CONCLUSION: This study shows that prolonged fasting is still common in pediatric anesthesia in Germany that pulmonary aspiration with postoperative respiratory distress is rare and that improvements to current local fasting regimens and national fasting guidelines are urgently needed.
BACKGROUND: Prolonged fasting before anesthesia is still common in children. Shortened fasting times may improve the metabolic and hemodynamic condition during induction of anesthesia and the perioperative experience for parents and children and simplify perioperative management. As a consequence, some centers in Germany have reduced fasting requirements, but the national guidelines are still unchanged. AIMS: This prospective multicenter observational study was initiated by the Scientific Working Group for Pediatric Anesthesia of the German Society of Anesthesiology and Intensive Care Medicine to evaluate real fasting times and the incidence of pulmonary aspiration before a possible revision of national fasting guidelines. METHODS: After the Ethics Committee's approval, at least 3000 children were planned to be enrolled for this analysis. Patient demographics, real fasting times, anesthetic and surgical procedures and occurrence of regurgitation or pulmonary aspiration were documented using a standardized case report form. Results were presented as median [interquartile range] (range) or incidence (percentage). RESULTS: At ten pediatric centers, 3324 children were included between October 2018 and May 2019. The real fasting times for large meals were 14 [12.2-15.6] (0.5-24) hours, for light meals 9 [5.6-13.3] (0.25-28.3) hours, for formula milk 5.8 [4.5-7.4] (0.9-24) hours, for breast milk 4.8 [4.2-6.3] (1.3-25.3) hours and for clear fluids 2.7 [1.5-6] (0.03-22.8) hours. Prolonged fasting (deviation from guideline >2 hours) was reported for large meals in 88.3%, for light meals in 54.7%, for formula milk in 44.4%, for breast milk in 25.8% and for clear fluids in 34.2%. Eleven cases (0.33%) of regurgitation, four cases (0.12%) of suspected pulmonary aspiration and two cases (0.06%) of confirmed pulmonary aspiration were reported; all of them could be extubated after the end of the procedure and recovered without any incidents. CONCLUSION: This study shows that prolonged fasting is still common in pediatric anesthesia in Germany that pulmonary aspiration with postoperative respiratory distress is rare and that improvements to current local fasting regimens and national fasting guidelines are urgently needed.
Authors: Claudia Neumann; Grigorij Schleifer; Nadine Strassberger-Nerschbach; Johannes Kamp; Gregor Massoth; Alexandra Görtzen-Patin; Dishalen Cudian; Markus Velten; Mark Coburn; Ehrenfried Schindler; Maria Wittmann Journal: J Clin Med Date: 2022-01-19 Impact factor: 4.241