Thomas Mark, Morrison Christa, Newton Richard, Schindler Ehrenfried
Department of Anaesthesia, Great Ormond Street Hospital, London, UK.
Department of Anaesthesia, Royal Sussex County Hospital, Brighton, UK.
Paediatr Anaesth. 2018 May;28(5):411-414. doi: 10.1111/pan.13370. Epub 2018 Apr 27.
Pediatric anesthetic guidelines for the management of preoperative fasting of clear fluids are currently 2 hours. The traditional 2 hours clear fluid fasting time was recommended to decrease the risk of pulmonary aspiration and is not in keeping with current literature. It appears that a liberalized clear fluid fasting regime does not affect the incidence of pulmonary aspiration and in those who do aspirate, the sequelae are not usually severe or long-lasting. With a 2-hour clear fasting policy, the literature suggests that this translates into 6-7 hours actual duration of fasting with several studies up to 15 hours. Fasting for prolonged periods increases thirst and irritability and results in detrimental physiological and metabolic effects. With a 1-hour clear fluid policy, there is no increased risk of pulmonary aspiration and studies demonstrate the stomach is empty. There is less nausea and vomiting, thirst, hunger, and anxiety, if allowed a drink closer to surgery. Children appear more comfortable, better behaved and possibly more compliant. In children less than 36 months this has positive physiological and metabolic effects. It is practical to allow children to drink until 1 hour prior to anesthesia on the day of surgery. In this joint consensus statement, the Association of Paediatric Anaesthetists of Great Britain and Ireland, the European Society for Paediatric Anaesthesiology, and L'Association Des Anesthésistes-Réanimateurs Pédiatriques d'Expression Française agree that, based on the current convincing evidence base, unless there is a clear contraindication, it is safe and recommended for all children able to take clear fluids, to be allowed and encouraged to have them up to 1 hour before elective general anesthesia.
目前，小儿麻醉中关于清亮液体术前禁食管理的指南是2小时。传统的2小时清亮液体禁食时间是为了降低肺误吸风险而推荐的，但与当前文献不符。似乎放宽清亮液体禁食方案并不影响肺误吸的发生率，而且对于发生误吸的患儿，后遗症通常并不严重或持续时间不长。根据2小时清亮液体禁食政策，文献表明这相当于实际禁食6 - 7小时，多项研究显示可达15小时。长时间禁食会增加口渴和烦躁情绪，并产生有害的生理和代谢影响。采用1小时清亮液体政策，肺误吸风险不会增加，且研究表明胃是空的。如果在手术前允许患儿饮水，恶心、呕吐、口渴、饥饿和焦虑会减少。患儿看起来更舒适、行为更好，可能也更配合。对于36个月以下的儿童，这具有积极的生理和代谢影响。在手术当天，允许患儿在麻醉前1小时饮水是可行的。在这份联合共识声明中，英国和爱尔兰小儿麻醉师协会、欧洲小儿麻醉学会以及法语国家小儿麻醉师与复苏医师协会一致认为，基于目前令人信服的证据基础，除非有明确禁忌证，对于所有能够饮用清亮液体的儿童，允许并鼓励他们在择期全身麻醉前1小时饮用清亮液体是安全且推荐的。
