Preoperative fasting in children.
The development of new preoperative fasting guidelines in paediatrics was reviewed in the light of present knowledge and some recent investigations. Although the proportion of healthy children with the potential risk of aspiration pneumonitis is relatively high (60-75%), the incidence of aspiration is low--1 to 8.6 in 10,000. In healthy children, there is no increase in the risk of aspiration by allowing them to drink clear fluids up to 2-3 hours before anaesthesia when compared with the conventional fasting regimen. The children are less thirsty and less irritable. The occurrence of hypoglycaemia and hypovolaemia in small infants may also be reduced. However, it is essential to identify high risk cases by clinical judgement and to treat them differently in their management. It is useful to have simple and explicit preoperative fasting instructions for parents to follow, especially in the day case setting. It is essential to note that the laryngeal mask airway (LMA) does not protect the patient's airway against the risk of regurgitation and aspiration of gastric contents in the same way as an endotracheal tube. Hence, constant vigilance is required when LMA is used in children.
Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories.
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D002648:Child; D002675:Child, Preschool; D004326:Drinking; D005215:Fasting / Q000378:metabolism / Q000502:physiology; D005746:Gastric Emptying / Q000502:physiology; D006801:Humans; D007223:Infant; D017214:Laryngeal Masks; D011015:Pneumonia, Aspiration / Q000209:etiology; D011300:Preoperative Care; D012307:Risk Factors