Department of Anesthesiology, Loma Linda University, Loma Linda, California 92354, USA.
Curr Opin Anaesthesiol. 2012 Jun;25(3):315-20. doi: 10.1097/ACO.0b013e3283530de1.
Clinical studies and new guidelines are frequently being published in the area of preoperative fasting. A growing population of patients with obstructive sleep apnea is being referred for outpatient procedures including adenotonsillectomy.
Recently published preoperative fasting guidelines for pediatric patients are covered along with studies comparing gastric volume following different fasting intervals. Pediatric obstructive sleep apnea is discussed. Clinical presentation, severity, perioperative risks, and controversies as whether outpatient procedures are suitable for these patients are presented. New data covering different perioperative aspects are presented.
A more liberal preoperative intake is encouraged with fasting for 2 h for clear liquids, 4 h for breast milk, 6 h for formula and light meals, and 8 h for heavy meals is widely accepted. Interpersonal variation in residual gastric volume exists. Children with obstructive sleep apnea under 3 years of age and those with severe obstructive sleep apnea and comorbidities are not candidates for ambulatory surgery. Polysomnography has specific preoperative indications. Dexmedetomidine can decrease emergence agitation and has an opioid-sparing effect. Intravenous acetaminophen is presented as an opioid-sparing analgesic. Dexamethasone is effective in preventing postoperative nausea without increased risk of bleeding. Surgical techniques may affect postoperative pain.
术前禁食领域经常发表临床研究和新指南。越来越多患有阻塞性睡眠呼吸暂停的患者被转介接受门诊手术，包括腺样体扁桃体切除术。
本文涵盖了最近发表的儿科患者术前禁食指南，并比较了不同禁食时间间隔后的胃容量。讨论了儿科阻塞性睡眠呼吸暂停。介绍了临床表现、严重程度、围手术期风险以及关于这些患者是否适合门诊手术的争议。提出了涵盖不同围手术期方面的新数据。
广泛接受的禁食方案为：2 小时内可饮用清水，4 小时内可饮用母乳，6 小时内可饮用配方奶和清淡食物，8 小时内可饮用固体食物。胃内残余物的个体差异存在。3 岁以下的儿童、患有严重阻塞性睡眠呼吸暂停和合并症的儿童，以及患有阻塞性睡眠呼吸暂停的儿童不适合进行日间手术。多导睡眠图具有特定的术前适应证。右美托咪定可减少苏醒期躁动，并具有阿片类药物节省作用。静脉用对乙酰氨基酚被推荐为一种阿片类药物节省的镇痛药物。地塞米松可有效预防术后恶心，且不会增加出血风险。手术技术可能会影响术后疼痛。
