Aroonpruksakul Naiyana, Punchuklang Wiruntri, Kasikan Khanita, Laotaweesuk Napatchanan, Phoson Patcharee, Khongrod Rungrat, Kiatchai Taniga
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Transl Pediatr. 2023 Feb 28;12(2):146-154. doi: 10.21037/tp-22-358. Epub 2023 Feb 13.
Preoperative fasting time for food and clear liquid was recommended as 2 and 6 h to prevent pulmonary aspiration. Prolonged fasting led to ketosis, hypotension, and patient discomfort. This study aimed to investigate the actual duration of preoperative fasting in pediatric patients, its effects on hunger and thirst, and factors that influence hunger and thirst.
This prospective observational study recruited participants aged 0-15 years who were scheduled for elective surgery or for other procedures to be performed under general anesthesia in a tertiary care center. All parents or participants were asked to report the fasting time for food and clear liquid. Participants aged 7-15 years self-rated their degree of hunger and thirst using a 0-10 scale. For participants aged less than 7 years, parents were asked to rate their child's degree of hunger based on the child's behavior. Dextrose-containing intravenous fluid administration and anesthesia start time were collected.
Three hundred and nine participants were included. The overall median [interquartile range; IQR] fasting duration for food and clear liquid was 11.1 h [IQR: 8.0, 14.0] and 10.0 h [IQR: 7.2, 12.5], respectively. The overall median hunger and thirst score was 7 [IQR: 5, 9] and 5 [IQR: 0, 7.5], respectively. High hunger score was reported in 76.4% of participants. There was no correlation between fasting time for food and hunger score [Spearman's rank correlation coefficient (Rho): -0.150, P=0.008], or between fasting time for clear liquid and thirst score (Rho: 0.007, P=0.955). Zero to 2-year-old participants had a significantly higher hunger score compared to older participants (P<0.001) and a higher proportion (80-90%) of high hunger score regardless of anesthesia start time. Although dextrose-containing fluid was administered ≥10 mL/kg, 85.7% of this group still reported high hunger score (P=0.008). Ninety percent of participants who had anesthesia start time after 12:00 PM reported high hunger score (P=0.044).
The actual duration of preoperative fasting was found to be longer than the recommendation for both food and liquid in pediatric surgical population. Younger age group and anesthesia start time in the afternoon were factors associated with high hunger score.
术前禁食固体食物和清液的时间分别建议为2小时和6小时，以防止肺误吸。禁食时间延长会导致酮症、低血压和患者不适。本研究旨在调查儿科患者术前禁食的实际时长、其对饥饿和口渴的影响以及影响饥饿和口渴的因素。
这项前瞻性观察性研究招募了年龄在0至15岁之间、计划在三级医疗中心接受择期手术或在全身麻醉下进行其他手术的参与者。所有家长或参与者都被要求报告固体食物和清液的禁食时间。7至15岁的参与者使用0至10分的量表对自己的饥饿和口渴程度进行自评。对于年龄小于7岁的参与者，要求家长根据孩子的行为对其饥饿程度进行评分。收集含葡萄糖静脉输液给药情况和麻醉开始时间。
共纳入309名参与者。固体食物和清液的总体禁食时长中位数[四分位间距；IQR]分别为11.1小时[IQR：8.0，14.0]和10.0小时[IQR：7.2，12.5]。饥饿和口渴评分的总体中位数分别为7分[IQR：5，9]和5分[IQR：0，7.5]。76.4%的参与者报告饥饿评分较高。固体食物禁食时间与饥饿评分之间无相关性[斯皮尔曼等级相关系数（Rho）：-0.150，P = 0.008]，清液禁食时间与口渴评分之间也无相关性（Rho：0.007，P = 0.955）。与年龄较大的参与者相比，0至2岁的参与者饥饿评分显著更高（P < 0.001），且无论麻醉开始时间如何，饥饿评分较高的比例也更高（80 - 90%）。尽管给予了≥10 mL/kg的含葡萄糖液体，但该组中85.7%的参与者仍报告饥饿评分较高（P = 0.008）。下午12:00之后开始麻醉的参与者中，90%报告饥饿评分较高（P = 0.044）。
在儿科手术人群中，发现术前禁食的实际时长比固体食物和液体的建议时长更长。年龄较小的群体以及下午的麻醉开始时间是与高饥饿评分相关的因素。
