Sturdivant Austin, Roberts Christian, Nahr Andrew, Bryan Kayla G, Sheffer Benjamin W, Spence David D, Sawyer Jeffrey R, Kelly Derek M
University of Tennessee Health Science Center, Memphis, TN.
University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN.
J Pediatr Soc North Am. 2024 Feb 5;5(4):751. doi: 10.55275/JPOSNA-2023-751. eCollection 2023 Nov.
: The American Society of Anesthesiologists (ASA) recommends fasting before surgery: clear liquids (2 hrs), breast milk (4 hrs), light meal (6 hrs), and fried foods/fatty foods/meat (> 8 hrs). In emergencies, guidelines are bypassed for timely surgical intervention. Pediatric post-anesthesia complications caused by violating fasting guidelines remain controversial. The aim of this study was to compare the risk of post-anesthetic complications in patients who met and did not meet ASA fasting guidelines for pediatric orthopaedic emergency procedures. Patients were retrospectively identified who had emergent procedures at a level 1 pediatric trauma center from 2010 to 2020. Patients were divided into two groups: those meeting current ASA fasting criteria of fasting and those who did not. Charts were reviewed for complications of gastric content aspiration during or following anesthesia. There were 321 patients who met inclusion criteria for emergency orthopaedic surgeries. Of these, 264 (82%) met fasting guidelines, and 57 (18%) did not. One patient who met preoperative fasting status needed postoperative supplemental oxygen and met criteria to be reported as an adverse event. Of the 57 patients not meeting fasting guidelines, there were no anesthesia-reported adverse events. : No increased risk was found with anesthesia in nonfasted patients with orthopaedic emergencies undergoing general anesthesia during the perioperative period in this underpowered, pilot study. No respiratory complications (pulmonary aspiration, intraoperative or postoperative emesis, or postoperative respiratory support) were reported in patients who did not meet fasting guidelines. The authors believe this is a valuable starting point for further research into fasting criteria in pediatric trauma patients. III •No increased risk was found with anesthesia in nonfasted patients with orthopaedic emergencies undergoing general anesthesia during the perioperative period.•Modern anesthesia techniques are tailored to minimize risk of pulmonary aspiration in patients with unknown fasting status.•The rate of pulmonary complications following modern anesthesia in children remains so small as to suggest that additional research is needed to determine if fasting guidelines are truly necessary in the majority of cases or if other factors beyond the time since last oral intake should be more carefully considered.
美国麻醉医师协会（ASA）建议术前禁食：清水（2小时）、母乳（4小时）、清淡饮食（6小时）以及油炸食品/高脂食品/肉类（>8小时）。在紧急情况下，为了及时进行手术干预可绕过这些指南。违反禁食指南导致的小儿麻醉后并发症仍存在争议。本研究的目的是比较在小儿骨科急诊手术中符合和不符合ASA禁食指南的患者麻醉后并发症的风险。回顾性纳入2010年至2020年在一级小儿创伤中心接受急诊手术的患者。患者分为两组：符合当前ASA禁食标准的患者和不符合的患者。查阅病历以了解麻醉期间或之后胃内容物误吸的并发症情况。共有321例患者符合急诊骨科手术的纳入标准。其中，264例（82%）符合禁食指南，57例（18%）不符合。1例符合术前禁食状态的患者术后需要补充氧气，符合不良事件报告标准。在57例不符合禁食指南的患者中，未出现麻醉报告的不良事件。：在这项样本量不足的初步研究中，接受全身麻醉的骨科急诊非禁食患者在围手术期麻醉未发现风险增加。不符合禁食指南的患者未报告呼吸并发症（肺误吸、术中或术后呕吐或术后呼吸支持）。作者认为这是进一步研究小儿创伤患者禁食标准的一个有价值的起点。三•接受全身麻醉的骨科急诊非禁食患者在围手术期麻醉未发现风险增加。•现代麻醉技术旨在将禁食状态未知患者的肺误吸风险降至最低。•小儿现代麻醉后肺部并发症发生率仍然很低，这表明需要进一步研究以确定在大多数情况下禁食指南是否真的必要，或者是否应更仔细地考虑末次口服摄入时间以外的其他因素。
