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Child Health Guideline Identifier

Anaesthesia - Fasting Guideline

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Purpose

To provide standardised fasting guidelines for children undergoing a medical or surgical procedure requiring anaesthesia or sedation.

Aim

To ensure children are fasted for the appropriate length of time prior to a planned medical or surgical procedure requiring a general anaesthetic. This is important to minimise the stress imposed on children due to excessive pre-operative fasting.

Rationale/Background

  • Fasting prior to anaesthesia minimizes the risk of aspirating stomach contents into the lungs.
  • The stomach empties clear fluids in a rapid and predictable manner, therefore evidence shows these require a shorter period of fasting than other types of fluid or food.
  • Children have frequently been fasting longer than necessary before anaesthesia. This may negatively affect their metabolic state, the way they wake up after anaesthesia and add to any emotional stress for the child and family. This approach will improve this.

Exceptions to guideline

Children at increased risk are those with delayed stomach emptying or gastro-oesophogeal reflux. Discussion with the individual anaesthetist will be required before implementing the guidelines for these children with:

  • Gastro‐oesophageal reflux (GORD)
  • Renal failure
  • Surgical contra‐indications
  • Impaired swallow, for example:
    • Severe cerebral palsy
    • Oesophageal strictures and/or achalasia,
    • Patients fed by gastrostomy

Definition of clear fluid

Clear fluids are those fluids which, when held to the light, are transparent. They include clear juices, glucose-based drinks, cordials, Pedialyte and water. They do not include juice with pulp or milk-based products or jelly.

Guidance

Clear Fluids

Moderate amounts of clear fluids should be offered routinely until 1 hour prior to the planned procedure.

  • Moderate amounts of clear fluid are the usual amount of fluid that a child drinks, up to a maximum of 1 cup.
  • Infants (0 - 12 months) may drink their usual amount of fluid as Pedialyte or water in their bottle.

Food and non-clear liquids

Longer fasting times for non-clear liquids and food are required. These are:

  • Last breast milk or infant formula feed to finish no later than 4 hours before planned procedure.
  • Last milk drink or food no later than 6 hours before planned procedure.
  • All patients should be advised and encouraged to have a drink of clear fluid before leaving home.
  • All patients, presenting on the day of their surgery should have a drink of clear fluid on arrival, unless their surgery is due in less than 1 hour.
  • Inpatients on morning list (except cardiac see below) to be offered clear fluid by 0730.
  • Patients should be offered clear fluids at regular intervals (1-2 hourly) until instructed to stop by the Anaesthetist who will call to stop fluids
  • Please see important instructions on exceptions for specific lists below.

Operating lists for which specific instructions apply

Starship Children's hospital

  • Inpatients first on morning cardiac list to be offered clear fluid before 0630.
  • Haematology/Oncology: stop clear fluids when patients 3 in front are sent for.
  • Gastroenterology and ORL short cases: stop clear fluids when patients 2 in front are sent for.

Oral medication

Please continue regular oral medications unless otherwise requested by the anesthetist. Medications can be taken with clear fluid.

Acute surgery and anaesthesia

Discuss fasting plan with Anaesthetist at booking of acute case.

  • Patients receiving IV fluids or IV pain relief will not usually be suitable for this guideline.
  • Other patients awaiting surgery should be offered clear fluids in accordance with the guidelines until instructed to stop by the nurse floor coordinator or the Anaesthetic Co-ordinator.

Contacting the Anaesthetist

  • For elective cases, the Anaesthetist for the list should be contacted first for all queries regarding fasting.
  • For emergency cases and after hours the Anaesthetic Co-ordinator should be contacted.

Example fasting instructions for families for elective morning or afternoon lists

Morning Operation List

Starting at 0830

Please fast from 0230 for food or milk and continue clear fluids until 0730
Any patient arriving before 7.30 should be offered clear fluids.

Afternoon Operation List

Starting at 1330

Please fast from 0730 for food or milk and continue clear fluids until 1230
Any patient arriving before 12.30 should be offered clear fluids.

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Document Control

  • Date last published: 10 September 2018
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Anaesthesia
  • Owner: Niall Wilton
  • Editor: Greg Williams
  • Review frequency: 2 years

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