Arun B G, Korula Grace
Department of Anaesthesiology Critical Care and Pain, Christian Medical College, Vellore, Tamilnadu, India.
J Anaesthesiol Clin Pharmacol. 2013 Jan;29(1):88-91. doi: 10.4103/0970-9185.105810.
Prolonged preoperative fasting in children is a common problem, especially in highvolume centers. All international professional society guidelines for preoperative fasting recommend 2 h for clear fluids, 4 h for breast milk and 6 h for solids, nonhuman and formula milk in children. These guidelines are rarely adhered to in practice.
An audit was undertaken to determine the length of preoperative fasting time in children and its causes.
Cross-sectional study of 50 children below 15 years posted for elective surgeries.
An initial audit was performed at our institution on preoperative fasting time in 50 children below 15 years of age for elective surgeries. The mean preoperative fasting times were found to be much longer than the recommended times. Ward nurses were then educated about internationally recommended preoperative fasting guidelines in children. Anesthesiologists started coordinating with surgeons and ward nurses to prescribe water for children waiting for more than 2 h based on changes in surgery schedule by instructing ward nurses through telephone on the day of surgery. A reaudit was done 6 months after the initial audit.
SPSS 16 software.
The initial audit revealed a mean preoperative fasting time of 11.25 h and 9.25 h for solids and water, respectively. Incorrect orders by ward nurses (74%) and change in the surgical schedule (32%) were important causes. After changing the preoperative system, mean preoperative fasting times in children decreased to 9 h and 4 h for solids and water, respectively in reaudit. Change in surgical schedule (30%) was the major cause for prolonged preoperative fasting in reaudit.
Simple steps such as education of ward nurses and better coordination among the anesthesiologists, surgeons and nurses can greatly reduce unnecessary preoperative starvation in children.
儿童术前长时间禁食是一个常见问题，尤其是在手术量大的中心。所有国际专业学会关于术前禁食的指南都建议儿童饮用清液禁食2小时，饮用母乳禁食4小时，食用固体食物、非母乳和配方奶禁食6小时。但这些指南在实际操作中很少得到遵守。
进行一项审计，以确定儿童术前禁食时间及其原因。
对50名15岁以下择期手术患儿进行横断面研究。
我们机构对50名15岁以下择期手术患儿的术前禁食时间进行了初步审计。发现术前平均禁食时间远长于推荐时间。随后对病房护士进行了关于国际推荐的儿童术前禁食指南的培训。麻醉医生开始与外科医生和病房护士协调，根据手术日程的变化，在手术当天通过电话指示病房护士为等待超过2小时的儿童供水。在初步审计6个月后进行了重新审计。
SPSS 16软件。
初步审计显示，固体食物和水的术前平均禁食时间分别为11.25小时和9.25小时。病房护士的错误医嘱（74%）和手术日程的变更（32%）是重要原因。改变术前系统后，重新审计中儿童固体食物和水的术前平均禁食时间分别降至9小时和4小时。手术日程的变更（30%）是重新审计中术前禁食时间延长的主要原因。
诸如对病房护士进行培训以及麻醉医生、外科医生和护士之间更好地协调等简单措施，可以大大减少儿童不必要的术前饥饿。
