Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Children do well with shorter fast before surgery

28.04.2005


Children facing surgery can be made more comfortable with little risk by allowing them to have certain liquids up to two hours before the operation, a new review of recent studies has found.

Like adults, children are often required to go without food or drink up to a half-day before surgery to prevent their stomach contents from being regurgitated or sucked into the lungs under general anesthesia. In the review of 43 randomized controlled trials involving 2,350 children, only one case of regurgitation or aspiration of food or drink into the lungs was reported, according to Marian Brady of the Glasgow Caledonian University in Scotland and colleagues.

The review appears in the April issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic. There is no evidence to suggest that children given liquids two hours before surgery have higher stomach volumes or more acidic stomach contents than those who undergo longer fasts, the researchers found. Stomach volume and acidity are two factors thought to influence the risk and severity of aspiration.



Although most research evidence now supports relaxed fasting standards, “kick-starting an evolution in fasting policies remains a difficult task,” Brady says. She notes that some hospitals still require patients to eat or drink nothing after midnight the day of surgery, a “practice that should no longer be tolerated,” she says. “Most children can safely drink clear liquids until two hours before surgery, although more research is needed for some groups of children,” Brady and colleagues write. Not surprisingly, children allowed a drink closer to surgery said they were less hungry and thirsty and more comfortable. Physicians also reported that these patients were better behaved.

Children who are obese, diabetic or have stomach disorders may be more likely to regurgitate, and Brady says more studies are needed to show whether these children can safely drink up to a few hours before surgery.“Nurses and anesthesiologists are anxious to ensure the safety of children, so they are sticking to what they know to be safe fasting policies. Things are beginning to change but change is slow,” Brady says.

Dr. Donna Caniano, a pediatric surgeon at Children’s Hospital of Columbus, Ohio, and chairperson of the American Academy of Pediatrics surgery section, says preoperative fasting times among children “can be very variable,” depending on where the patients are waiting for surgery and whether food and drink are available. In her hospital, Caniano says, guidelines about preoperative fasting are strictly followed “and if they are violated, we will not go ahead with surgery.” At Children’s Hospital of Columbus, patients can drink clear liquids up to two hours before surgery and eat solid foods eight hours before surgery.

The evidence for allowing solid food closer to surgery is less definitive, Brady and colleagues conclude. Although no cases of regurgitation or aspiration were reported in the studies in which children ate plain cookies or cooked rice cereal, there was some evidence that stomach volumes were higher among these children. “At present, the available evidence does not support a shift in practice from the current established guidelines which permit children solid food up to six or eight hours preoperatively,” Brady and colleagues write.

The researchers found very few studies on milk drinking before surgery, which was “especially surprising given the reliance of younger children on this form of nutritional intake,” Brady says. More studies could help researchers determine how milk contributes to stomach volume and acidity, since milk curdles in the stomach and acts more like a solid than liquid, she notes.

Many of the studies examined in the review only reported stomach volume and acidity, without noting any adverse effects on surgery. “I think one of the most vital things to include in future studies in this area would be to encourage researchers to report the incidence of aspiration, regurgitation or any adverse events related to fasting regimes,” Brady says.

The American Society of Anesthesiologists 1999 guidelines recommend a two-hour fast from clear liquids, a four-hour fast from breast milk and a six-hour fast from formula and a six- to eight-hour solid food fast for infants and children before surgery. M. Brady et al. Preoperative fasting for preventing perioperative complications in children (Review).The Cochrane Database of Systematic Reviews 2005, Issue 2

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.

Marian Brady | EurekAlert!
Further information:
http://www.cochrane.org
http://www.hbns.org
http://www.cfah.org

More articles from Health and Medicine:

nachricht Chances to treat childhood dementia
24.07.2017 | Julius-Maximilians-Universität Würzburg

nachricht World first: Massive thrombosis removed during early pregnancy
20.07.2017 | Universitätsspital Bern

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: 3-D scanning with water

3-D shape acquisition using water displacement as the shape sensor for the reconstruction of complex objects

A global team of computer scientists and engineers have developed an innovative technique that more completely reconstructs challenging 3D objects. An ancient...

Im Focus: Manipulating Electron Spins Without Loss of Information

Physicists have developed a new technique that uses electrical voltages to control the electron spin on a chip. The newly-developed method provides protection from spin decay, meaning that the contained information can be maintained and transmitted over comparatively large distances, as has been demonstrated by a team from the University of Basel’s Department of Physics and the Swiss Nanoscience Institute. The results have been published in Physical Review X.

For several years, researchers have been trying to use the spin of an electron to store and transmit information. The spin of each electron is always coupled...

Im Focus: The proton precisely weighted

What is the mass of a proton? Scientists from Germany and Japan successfully did an important step towards the most exact knowledge of this fundamental constant. By means of precision measurements on a single proton, they could improve the precision by a factor of three and also correct the existing value.

To determine the mass of a single proton still more accurate – a group of physicists led by Klaus Blaum and Sven Sturm of the Max Planck Institute for Nuclear...

Im Focus: On the way to a biological alternative

A bacterial enzyme enables reactions that open up alternatives to key industrial chemical processes

The research team of Prof. Dr. Oliver Einsle at the University of Freiburg's Institute of Biochemistry has long been exploring the functioning of nitrogenase....

Im Focus: The 1 trillion tonne iceberg

Larsen C Ice Shelf rift finally breaks through

A one trillion tonne iceberg - one of the biggest ever recorded -- has calved away from the Larsen C Ice Shelf in Antarctica, after a rift in the ice,...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Closing the Sustainability Circle: Protection of Food with Biobased Materials

21.07.2017 | Event News

»We are bringing Additive Manufacturing to SMEs«

19.07.2017 | Event News

The technology with a feel for feelings

12.07.2017 | Event News

 
Latest News

Ultrathin device harvests electricity from human motion

24.07.2017 | Power and Electrical Engineering

Scientists announce the quest for high-index materials

24.07.2017 | Materials Sciences

ADIR Project: Lasers Recover Valuable Materials

24.07.2017 | Materials Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>