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Preoperative fasting in children: review of existing guidelines and recent developments
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Asklepios Klin Sankt Augustin, Dept Paediat Anaesthesia, St Augustin, NRW, Germany.
Hannover Med Sch, Clin Anaesthesiol & Intens Care Med, Hannover, Germany.
Royal Manchester Childrens Hosp, Manchester, Lancs, England.
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2018 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 120, no 3, p. 469-474Article, review/survey (Refereed) Published
Abstract [en]

The current guidelines for preoperative fasting recommend intervals of 6, 4, and 2 h (6-4-2) of fasting for solids, breast milk, and clear fluids, respectively. The objective is to minimize the risk of pulmonary aspiration of gastric contents, but also to prevent unnecessarily long fasting intervals. Pulmonary aspiration is rare and associated with nearly no mortality in paediatric anaesthesia. The incidence may have decreased during the last decades, judging from several audits published recently. However, several reports of very long fasting intervals have also been published, in spite of the implementation of the 6-4-2 fasting regimens. In this review, we examine the physiological basis for various fasting recommendations, the temporal relationship between fluid intake and residual gastric content, and the pathophysiological effects of preoperative fasting, and review recent publications of various attempts to reduce the incidence of prolonged fasting in children. The pros and cons of the current guidelines will be addressed, and possible strategies for a future revision will be suggested.

Place, publisher, year, edition, pages
2018. Vol. 120, no 3, p. 469-474
Keywords [en]
anaesthesia, aspiration pneumonia, children, gastric emptying, preoperative period
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-365270DOI: 10.1016/j.bja.2017.11.080ISI: 000438191300011PubMedID: 29452803OAI: oai:DiVA.org:uu-365270DiVA, id: diva2:1264018
Available from: 2018-11-19 Created: 2018-11-19 Last updated: 2018-11-19Bibliographically approved

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Frykholm, Peter

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