Dalal Priti G, Malviya Shobha, Cravero Joseph, Fehr James
From the Department of Anesthesiology, Penn State Health, Penn State College of Medicine, Hershey, Pennsylvania.
Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
Anesth Analg. 2025 Mar 1;140(3):507-514. doi: 10.1213/ANE.0000000000007219. Epub 2024 Nov 19.
Several international pediatric anesthesia societies have endorsed a change in the traditional nil per os (NPO) cutoff of clear fluids (CF) from 2 hours to 1 hour. These recommendations were compiled from large-scale outcomes, gastric ultrasound, and quality improvement studies. The American Society of Anesthesiologists (ASA) recently published their updated guidelines. Despite the lack of prospective randomized studies with conclusive outcomes, several major children's health systems in North America have already implemented or are modifying their institutional guidelines for CF. The objectives of this survey were to evaluate the current practices, changing trends, perceived benefits, and barriers in reducing the NPO times for CF in children presenting for anesthesia.
After approval from the Penn State University Institutional Review Board, an electronic survey of the Pediatric Anesthesia Leadership Council (PALC, consortium of Pediatric Anesthesiology Chairs and Division Chiefs across the United States) members was conducted by the Society for Pediatric Anesthesia Quality and Safety Committee (SPA-QS) NPO Clears Task Force between June 2023 and October 2023. Inclusion criteria were PALC membership and single response from each institution.
A total of 88 member institutions were represented by the PALC group. The final response rate was 75 of 88 (85.2%) from across 33 states. Eighty-eight percent of the respondents belonged to a tertiary pediatric center, and 94.7% belonged to an academic setting. At the time of the survey, 8 out of 75 (10.6%) responding institutions followed 1-hour CF cutoff, 7 (9.3%) were in the process of changing to 1-hour and 60 (80%) followed a 2-hour cutoff. 55(73%) respondents actively encouraged CF up to the time they had to be NPO. 46.7% of the respondents reported significant issues (hypoglycemia, dehydration, difficulty in establishing intravenous access, patient and parental dissatisfaction) with prolonged fasting in children. The survey responses included multiple comments in favor of changing guidelines to 1 hour for CF in healthy young children. The overarching concern for implementation of 1-hour cutoff for CF was the potential medicolegal ramification of a policy change in the absence of an official statement from national professional societies.
The survey demonstrates growing trends toward implementing the reduced NPO time for CF to 1 hour nationally. Based on the current ASA guidelines, the SPA-QS committee recommends close attention to NPO times and strongly encourages CF consumption up to the recommended cutoff time. It appears reasonable to follow a 1-hour cutoff for CF as deemed appropriate by the attending anesthesiologist or the institution.
多个国际儿科麻醉学会已认可将传统的清亮液体禁食(NPO)截止时间从2小时改为1小时。这些建议是根据大规模研究结果、胃超声检查和质量改进研究汇总而成的。美国麻醉医师协会(ASA)最近发布了其更新指南。尽管缺乏具有确凿结果的前瞻性随机研究,但北美几家主要的儿童健康系统已经实施或正在修改其关于清亮液体的机构指南。本次调查的目的是评估当前的做法、变化趋势、感知到的益处以及在减少接受麻醉的儿童清亮液体禁食时间方面存在的障碍。
在宾夕法尼亚州立大学机构审查委员会批准后,儿科麻醉质量与安全委员会(SPA-QS)的NPO清亮液体特别工作组于2023年6月至2023年10月对儿科麻醉领导委员会(PALC,由美国各地的儿科麻醉科主任和科室主任组成的联盟)成员进行了电子调查。纳入标准为PALC成员资格且每个机构仅有一份回复。
PALC组共代表88个成员机构。最终回复率为来自33个州的88个机构中的75个(85.2%)。88%的受访者来自三级儿科中心,94.7%来自学术机构。在调查时,75个回复机构中有8个(10.6%)遵循1小时的清亮液体截止时间,7个(9.3%)正在改为1小时,60个(80%)遵循2小时的截止时间。55个(73%)受访者积极鼓励在必须禁食之前饮用清亮液体。46.7%的受访者报告称儿童长时间禁食存在重大问题(低血糖、脱水、建立静脉通路困难、患者及家长不满)。调查回复中包括多条支持将健康幼儿清亮液体指南改为1小时的意见。对于实施1小时清亮液体截止时间的总体担忧是,在没有国家专业协会官方声明的情况下,政策改变可能带来的法医学后果。
该调查表明在全国范围内将清亮液体禁食时间缩短至1小时的趋势正在增加。根据当前的ASA指南,SPA-QS委员会建议密切关注禁食时间,并强烈鼓励在建议的截止时间前饮用清亮液体。根据主治麻醉医师或机构的判断,遵循1小时的清亮液体截止时间似乎是合理的。