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 Penn study identifies new malaria parasites in wild bonobos
21.11.2017 | University of Pennsylvania School of Medicine

nachricht NIST scientists discover how to switch liver cancer cell growth from 2-D to 3-D structures
17.11.2017 | National Institute of Standards and Technology (NIST)

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: Nanoparticles help with malaria diagnosis – new rapid test in development

The WHO reports an estimated 429,000 malaria deaths each year. The disease mostly affects tropical and subtropical regions and in particular the African continent. The Fraunhofer Institute for Silicate Research ISC teamed up with the Fraunhofer Institute for Molecular Biology and Applied Ecology IME and the Institute of Tropical Medicine at the University of Tübingen for a new test method to detect malaria parasites in blood. The idea of the research project “NanoFRET” is to develop a highly sensitive and reliable rapid diagnostic test so that patient treatment can begin as early as possible.

Malaria is caused by parasites transmitted by mosquito bite. The most dangerous form of malaria is malaria tropica. Left untreated, it is fatal in most cases....

Im Focus: A “cosmic snake” reveals the structure of remote galaxies

The formation of stars in distant galaxies is still largely unexplored. For the first time, astron-omers at the University of Geneva have now been able to closely observe a star system six billion light-years away. In doing so, they are confirming earlier simulations made by the University of Zurich. One special effect is made possible by the multiple reflections of images that run through the cosmos like a snake.

Today, astronomers have a pretty accurate idea of how stars were formed in the recent cosmic past. But do these laws also apply to older galaxies? For around a...

Im Focus: Visual intelligence is not the same as IQ

Just because someone is smart and well-motivated doesn't mean he or she can learn the visual skills needed to excel at tasks like matching fingerprints, interpreting medical X-rays, keeping track of aircraft on radar displays or forensic face matching.

That is the implication of a new study which shows for the first time that there is a broad range of differences in people's visual ability and that these...

Im Focus: Novel Nano-CT device creates high-resolution 3D-X-rays of tiny velvet worm legs

Computer Tomography (CT) is a standard procedure in hospitals, but so far, the technology has not been suitable for imaging extremely small objects. In PNAS, a team from the Technical University of Munich (TUM) describes a Nano-CT device that creates three-dimensional x-ray images at resolutions up to 100 nanometers. The first test application: Together with colleagues from the University of Kassel and Helmholtz-Zentrum Geesthacht the researchers analyzed the locomotory system of a velvet worm.

During a CT analysis, the object under investigation is x-rayed and a detector measures the respective amount of radiation absorbed from various angles....

Im Focus: Researchers Develop Data Bus for Quantum Computer

The quantum world is fragile; error correction codes are needed to protect the information stored in a quantum object from the deteriorating effects of noise. Quantum physicists in Innsbruck have developed a protocol to pass quantum information between differently encoded building blocks of a future quantum computer, such as processors and memories. Scientists may use this protocol in the future to build a data bus for quantum computers. The researchers have published their work in the journal Nature Communications.

Future quantum computers will be able to solve problems where conventional computers fail today. We are still far away from any large-scale implementation,...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Ecology Across Borders: International conference brings together 1,500 ecologists

15.11.2017 | Event News

Road into laboratory: Users discuss biaxial fatigue-testing for car and truck wheel

15.11.2017 | Event News

#Berlin5GWeek: The right network for Industry 4.0

30.10.2017 | Event News

 
Latest News

Previous evidence of water on mars now identified as grainflows

21.11.2017 | Physics and Astronomy

NASA's James Webb Space Telescope completes final cryogenic testing

21.11.2017 | Physics and Astronomy

New catalyst controls activation of a carbon-hydrogen bond

21.11.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>