202406151409
Status:
Tags: Paed
Background
Sir Joseph Lister published 1st recommendation for preop fasting in 1883
6-4-2 rule
- 8h → large solid meals
- 6h → light meal
- 4h → breast milk
- 2h → clear fluid
Aspiration pneumonitis - Paed
ESAIC guideline
- encourages clear fluid intake 2h before anaes, and breast / formula milk 4h before, in infants <6mo of age.
- 1st fasting guideline using EBM methodology
- PICO
- systematic review
- GRADE to evaluate quality of evidence
- consensus process w/ Delphi
- 6-4-3-1
- 4 → formula
- 3 → breast milk
- 1 → clear fluid
6-4-3-1: Pro
- no significant ↑ of gastric residual volume
- ↓ unnecessarily prolonged fasting
- esp for more vulnerable population
6-4-3-1: Con
- overnight fasting not very harmful to healthy older children
- insignificant change in blood glucose, ketone bodies, BP, difficulties in IV insertion
Various guidelines
| First author | Society | Year | Country/Region | Solids heavy meal | Solids light meal | Infant formula | Breast milk | Clear Fluids |
|---|---|---|---|---|---|---|---|---|
| Raeder JC | Norwegian S An | 1995 | Norway | None | 6 | NA | 4 | 2 |
| ASA TF | ASA | 1999 | USA | 8 | 6 | NA | 2 | 2 |
| Soreide | SSAI | 2005 | Scandinavia | None | 6 | 4 | 4 | 2 |
| Smith | ESA | 2009 | Europe | None | 6 | 4 | 4 | 2 |
| ASA TF | ASA | 2011 | USA | 8 | 6 | ND | 4 | 2 |
| ASA TF | ASA | 2017 | USA | 8 | 6 | NR | 4 | 2 |
| Dobson | CAS | 2021 | Canada | 8 | 6 | 4 | 1 | |
| Frykholm | ESAIC | 2022 | Europe | None | 6/4 | 4 | 3 | 1/0+ |
| ASA TF | ASA | 2023 | USA | 8 | 6 | 4 | 2 |
other considerations
- non-compliance to NPO rules
- education to parents
- use modern technology
- education to parents