Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite.
BACKGROUND
International guidelines recommend 2 h of clear fluid fasting prior to general anesthesia. The pediatric anesthesia unit of Uppsala University Hospital has been implementing a more liberal fasting regime for more than a decade; thus, children scheduled for elective procedures are allowed to drink clear fluids until called to the operating suite.


OBJECTIVE
To determine the incidence of perioperative pulmonary aspiration in pediatric patients allowed unlimited intake of clear fluids prior to general anesthesia.


METHODS
Elective pediatric procedures between January 2008 and December 2013 were examined retrospectively by reviewing anesthesia charts and discharge notes in the electronic medical record system. All notes from the care event and available chest x-rays were examined for cases showing vomiting, regurgitation, and/or aspiration. Pulmonary aspiration was defined as radiological findings consistent with aspiration and/or postoperative symptoms of respiratory distress after vomiting during anesthesia.


RESULTS
Of the 10,015 pediatric anesthetics included, aspiration occurred in three (0.03% or 3 in 10,000) cases. No case required cancellation of the surgical procedure, intensive care or ventilation support, and no deaths attributable to aspiration were found. Pulmonary aspiration was suspected, but not confirmed by radiology or continuing symptoms, in an additional 14 cases.


CONCLUSIONS
Shortened fasting times may improve the perioperative experience for parents and children with a low risk of aspiration.
Department of Surgical Sciences, Anesthesia and Intensive Care, Uppsala University Hospital, Uppsala, Sweden.
Hanna
H
Andersson
Department of Surgical Sciences, Anesthesia and Intensive Care, Uppsala University Hospital, Uppsala, Sweden.
Björn
B
Zarén
Department of Surgical Sciences, Anesthesia and Intensive Care, Uppsala University Hospital, Uppsala, Sweden.
Peter
P
Frykholm
D000293:Adolescent; D000768:Anesthesia, General; D001628:Beverages / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005215:Fasting; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D011015:Pneumonia, Aspiration / Q000453:epidemiology* / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk
anesthesia general; fasting; incidence; intraoperative complications; pediatrics; respiratory aspiration of gastric contents