Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to theatre

Background: International guidelines recommend two hours of clear fluid fasting prior to general anesthesia. The pediatric anesthesia unit of Uppsala University Hospital implements a more liberal fasting regime for more than a decade; thus children scheduled for elective procedures are allowed to drink clear fluids until called to theatre. We hypothesized that this practice would not increase the risk of significant pulmonary aspiration. Aim: To determine the incidence of perioperative pulmonary aspiration in pediatric patients allowed unlimited intake of clear fluids prior to general anesthesia. Method: Elective pediatric procedures between January 2008 and December 2013 were examined retrospectively by reviewing anesthesia charts and discharge notes in the electronic medical record system. All notes from the care event and available chest x-rays were examined for cases showing vomiting, regurgitation and/or aspiration. Pulmonary aspiration was defined as radiological findings consistent with aspiration and/or postoperative symptoms of respiratory distress after vomiting during anesthesia. Results: Of the 10 015 pediatric anesthetics included, aspiration occurred in three (0.03 % or 3 in 10 000) cases. No case required cancellation of the surgical procedure, intensive care or ventilation support, and no deaths attributable to aspiration were found. Pulmonary aspiration was suspected, but not confirmed by radiology or continuing symptoms, in an additional fourteen cases. Conclusion: The incidence of perioperative pulmonary aspiration among pediatric patients allowed clear liquids prior to anesthesia was not increased compared with previous studies.