Perioperative fasting and children: A review article

This review provides an overview of the present knowledge on the aspects of preoperative fasting with the assessment of the evidence quality. A systematic research was conducted in electronic databases in order to identify trials published between 1990 and 2014 concerning preoperative fasting, early resumption of oral intake and the effects of oral carbohydrate mixtures on gastric emptying and postoperative recovery. The publications were classified in terms of their evidence level, scientific validity and clinical relevance. The key recommendations are that children be encouraged to drink clear fluids within up to 2 hours before elective surgery (including Caesarean section) and all but one member of the guideline groups consider that tea or coffee, with milk added (up to about one fifth of the total volume), are still clear fluids .Furthermore, solid food consumption should be prohibited for up to 6 hours before elective surgery for children. However, patients should not have their operation cancelled or delayed only because they are chewing gums or sucking a boiled sweet immediately prior to the induction of anaesthesia. These recommendations also apply to those patients with obesity, gastro-oesophageal reflux and diabetes. There is insufficient evidence to support the routine use of antacids, metoclopramide or H2-receptor antagonists before elective surgery in non-obstetric patients. Infants should be fed before elective surgery. Breast milk is considered a safe option for up to 4 hours and other kinds of milk for up to 6 hours. The present review takes into account the safety and possible benefits of preoperative carbohydrates while offering advice on the postoperative resumption of oral intake.