, et al
Surgical fasting guidelines in children: are we putting them into practice? [published online ahead of print April 21, 2016]
J Pediatr Surg
. doi:

Investigators from the University of Alberta, Edmonton, Alberta prospectively studied compliance with published guidelines for pre- and postoperative nothing by mouth (NPO) times in children admitted for surgical procedures requiring general anesthesia. These guidelines recommend no clear liquids for 2 hours, no breast milk for 4 hours, no formula, milk, or light meal for 6 hours, and no full or high-fat meal for 8 hours preoperatively. Data were prospectively collected on children having general, neurologic, or urologic operations at a children’s hospital during a 5-week study period. The medical records of study patients were reviewed and demographic and clinic data abstracted; surgical procedures were classified as complex, defined as non-routine procedures with an expected delay in recovery (primarily intra-abdominal procedures), or non-complex. In addition, the medical records were reviewed to estimate NPO time preoperatively, NPO time postoperatively, and total NPO time (defined as the duration from initiating NPO preoperatively until time of first nutrition postoperatively). NPO time preoperatively was compared to guideline recommendations. NPO times among children undergoing complex and non-complex surgeries were also compared.

Data were analyzed on 53 patients who primarily underwent general surgery procedures. The mean age was 6 years (range 2 weeks to 16.7 years), and the mean duration of hospital stay was 5 days (range 2–36 days). Ten patients underwent complex procedures; the other 43 underwent non-complex procedures.

The mean preoperative NPO time for all patients was 11 hours. One third of patients had their NPO time implemented at midnight or earlier the evening prior to their procedure. No patients received clear liquids until up to 2 hours prior to their procedure. Moreover, 70% of patients were NPO for more than 8 hours prior to their procedure.

Postoperatively, 71% of patients with non-complex surgeries resumed feeds within 8 hours of their procedure versus only 18% of those undergoing complex procedures. The mean time to first nutrition (ie, total NPO time) in the complex group was 63.6 hours and 23.8 hours among those in the non-complex group.

The authors conclude that observed preoperative NPO time exceeded current recommendations. They also observed that postoperative NPO time was significantly greater in patients who underwent complex surgical procedures than in those who had non-complex procedures.

Dr Iqbal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

NPO times are a constant source of frustration for families and health care providers alike. While fasting, children become cranky (as do their parents), and they are at risk for hypoglycemia and dehydration. Dehydration is a bigger problem in children presenting the day of surgery when supplemental intravenous fluids cannot be administered overnight. Conversely, noncompliance with NPO orders may increase the risk for aspiration and result in delaying elective...

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