Preoperative fasting time in children undergoing elective surgical procedures

Abstract

Objective: to verify the preoperative fasting time in children undergoing elective surgical procedures. Methods: cross-sectional study, carried out with information obtained from 20 children’s medical records, submitted to descriptive and inferential statistical analysis. Results: the median fasting time was 8.03 hours. The shortest time recorded was 7 hours and 45 minutes and the longest 17 hours and 30 minutes. School children had the longest pre-anesthetic fasting time. In 16 cases, fasting after midnight was prescribed. There was no statistically significant difference between fasting time and the variables age groups and surgical specialties. No correlation was found between the child’s age and fasting time. Conclusion: the median fasting time was shorter than that found in other studies. The patients fasted for longer intervals than recommended. Fasting time was not related to age group, surgical specialty, and age of the child. Descriptors: Fasting; Child; General Surgery; Humanization of Assistance. 1Universidade Estadual de Maringá. Maringá, PR, Brazil. Corresponding author: Larissa Silva Bergantini Avenida Colombo, 5790, Jardim Universitário, CEP: 87020900. Maringá, PR, Brazil. E-mail: [email protected] EDITOR IN CHIEF: Viviane Martins da Silva ASSOCIATE EDITOR: Renan Alves Silva Larissa Silva Bergantini1 Sueli Mutsumi Tsukuda Ichisato1 Mariana Salvadego Águila Nunes1 Carlos Alexandre Molena Fernandes1 How to cite this article: Bergantini LS, Ichisato SMT, Nunes MSÁ, Fernandes CAM. Preoperative fasting time in children undergoing elective surgical procedures. Rev Rene. 2021;22:e61347. DOI: https://doi.org/10.15253/2175-6783.20212261347 Bergantini LS, Ichisato SMT, Nunes MSÁ, Fernandes CAM Rev Rene. 2021;22:e61347. 2 Introduction Among the preoperative care with the surgical child in elective procedures, one can mention preoperative fasting or pre-anesthetic fasting, considered as the period before a surgery during which patients are prohibited from ingesting solids or liquids(1). The objective of preanesthetic fasting is to avoid regurgitation and consequent pulmonary aspiration of gastric contents by individuals undergoing anesthesia(2). When performing a retrospective of the practice, it is verified that the traditional nil per os (NPO) Latin expression meaning “nothing through the mouth” after midnight emerged in the 60’s, as a result of reports of occurrence of pulmonary aspiration associated with general anesthesia(3). Currently, the practice of NPO after midnight has been challenged, and new scientific evidence supports and emphasizes the need to overcome it(4). To this end, modern protocols, such as that of the American Society of Anesthesiologists (ASA), indicate the so-called 6-4-2 regimen, which provides for abstention from solid foods, breast milk and clear liquids (water and fruit juices without pulp, carbonated beverages, carbohydrate-rich nutritional drinks, clear tea and black coffee) respectively six, four and two hours before the surgical procedure and/or contrast-enhanced exams(1). In addition, recent research points to even shorter fasting periods for clear liquids, such as one hour before surgery(5-6). In front of this scenario, although a wide range of research supports the new guidelines for preoperative fasting, there seems to be a considerable gap between their practical application and what the evidence shows(7). The incidence of pulmonary aspiration is low; however, patients continue to fast for excessively long and unnecessary periods(8-9), and it is possible to notice some resistance by the health services to implement the new fasting recommendations(9). Pediatric patients end up suffering the consequences of prolonged fasting, among which are hypoglycemia, dehydration, sensation of hunger and thirst, discomfort, among others(3,9). In Brazil, the project Accelerating Total Postoperative Recovery (ACERTO) aims to disseminate practices for total recovery of the surgical patient, including appropriate pre-anesthesia fasting, which is endorsed by the Brazilian Association of Pediatric Surgery (Associação Brasileira de Cirurgia Pediátrica) (9-10). Despite that, in the country, similarly to what was mentioned above, the traditional fasting regimen seems to predominate in hospitals(11). In addition, after a broad search in the national literature, it was detected that studies on the subject among the pediatric population in the nursing field are scarce, despite the important role of this category in perioperative care for children. With this in mind, it is essential to evaluate the preoperative fasting time of children patients in the Brazilian context, in the light of recent protocols, particularly in the nursing field. Thus, the research question designed to guide this study was: what is the preoperative fasting time of children submitted to elective surgeries? Therefore, the objective was to verify the preoperative fasting time in children undergoing elective surgical procedure.