Department of Anaesthesia and Children's Research Centre, University Children's Hospital, Zurich, Switzerland.
Department of Psychiatry and Psychotherapy, University Hospital, Zurich, Switzerland.
Br J Anaesth. 2018 Sep;121(3):647-655. doi: 10.1016/j.bja.2018.02.065. Epub 2018 May 3.
The paediatric preoperative fasting time of 2 h for clear fluids, as suggested by guidelines, is often exceeded. Shorter preoperative fasting has been proposed to avoid potential outcomes such as dehydration, ketoacidosis, reduced arterial blood pressure, and patient discomfort. The aim of this study was to investigate whether liberal clear fluid intake until premedication significantly reduces actual fasting time and impacts gastric pH and residual volume.
Children (1-16 yr old, ASA I or II) undergoing elective procedures with general anaesthesia requiring tracheal intubation were randomised for clear fluid intake until premedication with midazolam (liberal) or 2 h fluid fasting (standard). Actual fasting times were recorded. Gastric content was sampled after tracheal intubation with an orogastric tube to determine gastric pH and residual volume. Data are presented as median [interquartile range].
We included 162 children aged 1.1-16 yr; gastric pH was determined in 138 patients. Patients' characteristics were similar in the two groups. The liberal fasting group had significantly shorter fasting times (48 [18.5-77.5] vs 234 [223.5-458.5] min; P<0.001). No significant difference was observed regarding gastric pH (1.6 [1.5-1.8] vs 1.6 [1.4-1.7]; P=0.237) or residual volume (0.38 [0.1-1.1] vs 0.43 [0.13-0.73] ml kg; P=0.535). Twelve patients (15%) in the liberal group (median fluid fasting 32 min) vs one patient (1%) had gastric residual volumes >2 ml kg (P=0.001).
Fluid intake until premedication allows for significantly shorter fasting times. Elevated gastric residual volumes may occur more often in patients with fasting times of 30 min or shorter.
NCT02603094.
儿科术前禁食 2 小时的建议，常被超过。较短的术前禁食被提议以避免潜在的结果，如脱水、酮症酸中毒、动脉血压降低和患者不适。本研究的目的是研究在给予咪达唑仑镇静前自由摄入清亮液体是否显著减少实际禁食时间，并影响胃 pH 值和胃残余量。
择期全身麻醉气管插管的患儿（1-16 岁，ASA I 或 II 级）被随机分为清亮液体摄入至咪达唑仑镇静前（自由）或 2 小时液体禁食（标准）。记录实际禁食时间。气管插管后用胃管抽取胃内容物，以确定胃 pH 值和胃残余量。数据以中位数（四分位距）表示。
我们纳入了 162 名 1.1-16 岁的患儿；138 名患者进行了胃 pH 值测定。两组患儿的特征相似。自由禁食组的禁食时间明显缩短（48 [18.5-77.5] vs 234 [223.5-458.5] min；P<0.001）。胃 pH 值（1.6 [1.5-1.8] vs 1.6 [1.4-1.7]；P=0.237）或胃残余量（0.38 [0.1-1.1] vs 0.43 [0.13-0.73] ml kg；P=0.535）无显著差异。自由组 12 名患者（15%）（中位禁食时间 32 min）与 1 名患者（1%）（P=0.001）胃残余量>2 ml kg。
在给予咪达唑仑镇静前摄入液体可显著缩短禁食时间。禁食时间为 30 分钟或更短时，胃残余量可能更常发生。
NCT02603094。
