Pre-operative fasting times in paediatric patients admitted to the orthopaedic department

Abstract

Background: Recent research has shown that children are often fasted for unnecessarily long intervals and prolonged fasting could have detrimental metabolic and behavioural effects in small children. In 2011, the European Society of Anaesthesiology proposed the 6-4-2 regimen for pre-operative fasting in paediatric patients. Solids, including semi-solid food and milk-containing products should be avoided 6 hours, breast milk, 4 hours and clear fluids 2 hours before anaesthesia induction respectively.

Methods: Patients aged 16 years and younger requiring emergency surgery within the Orthopaedics department were included in this audit over a three-month period. 49 patients were identified from the trauma lists issued daily by the Orthopoedics Department. Data was collected from patient's case notes.

Results: Out of 41 patients, 22 patients (54%) were advised to remain starved from fluids and solids from 2 am in the morning. On the other hand, 37% of the patients (15 patients) were advised to remain starved from midnight.

Conclusion: The majority of doctors that admit paediatric patients within the Orthopaedics Department seem to be unaware of the guidelines from the European Society of Anaesthesiology regarding pre-operative fasting times in children. As a result, these patients are fasted for unnecessarily long intervals leading to detrimental metabolic and behavioural effects.