title: The risk of shorter fasting time for pediatric deep sedation.
abstract: BACKGROUND
  Current guidelines adopted by the American Academy of Pediatrics calls for prolonged fasting times before performing pediatric procedural sedation and analgesia (PSA). PSA is increasingly provided to children outside of the operating theater by sedation trained pediatric providers and does not require airway manipulation. We investigated the safety of a shorter fasting time compared to a longer and guideline compliant fasting time. We tried to identify the association between fasting time and sedation-related complications.
  
  
  METHODS
  This is a prospective observational study that included children 2 months to 18 years of age and had an American Society of Anesthesiologists physical status classification of I or II, who underwent deep sedation for elective procedures, performed by pediatric critical care providers. Procedures included radiologic imaging studies, electroencephalograms, auditory brainstem response, echocardiograms, Botox injections, and other minor surgical procedures. Subjects were divided into two groups depending on the length of their fasting time (4-6 h and >6 h). Complication rates were calculated and compared between the three groups.
  
  
  RESULTS
  In the studied group of 2487 subjects, 1007 (40.5%) had fasting time of 4-6 h and the remaining 1480 (59.5%) subjects had fasted for >6 h. There were no statistically significant differences in any of the studied complications between the two groups.
  
  
  CONCLUSIONS
  This study found no difference in complication rate in regard to the fasting time among our subjects cohort, which included only healthy children receiving elective procedures performed by sedation trained pediatric critical care providers. This suggests that using shorter fasting time may be safe for procedures performed outside of the operating theater that does not involve high-risk patients or airway manipulation.
authors.affiliation: Division of Critical Care Medicine, St. Louis University, St. Louis, MO, USA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Clark
authors.affiliation: Department of Statistics, University of Missouri, Columbia, MO, USA.
authors.forename: Esma
authors.initials: E
authors.lastname: Birisci
authors.affiliation: Women's and Children's Hospital Campus, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Anderson
authors.affiliation: Women's and Children's Hospital Campus, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Anliker
authors.affiliation: Women's and Children's Hospital Campus, University of Missouri Health Care, Columbia, MO, USA.
authors.forename: Micheal A
authors.initials: MA
authors.lastname: Bryant
authors.affiliation: Department of Child Health, Division of Critical Care Medicine, University of Missouri School of Medicine, Columbia, MO, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Downs
authors.affiliation: Department of Child Health, Division of Critical Care Medicine, University of Missouri School of Medicine, Columbia, MO, USA.
authors.forename: Abdallah
authors.initials: A
authors.lastname: Dalabih
keywords: Fasting time; pediatric; sedation