Surgical Fasting Guidelines in Children: Are we putting them into practice?

Abstract Background Patients are traditionally kept fasting (NPO) from midnight prior to surgery, to prevent aspiration during anaesthesia. NPO time is continued postoperatively, out of concern for ileus. Prolonged periods of NPO place the pediatric population at risk for under-nutrition. Published guidelines for preoperative NPO times have been shown to be safe. The aim of this study was to investigate current pre- and post-operative feeding practices of children at a pediatric tertiary care hospital. Methods Medical charts were used to extract data prospectively from 53 patients undergoing general, neurosurgical, or urological procedures. Date and time of NPO periods were recorded as well as the physician's postoperative diet orders and diet progression. Surgical procedures were classified as complex or non complex by the surgeons. Data were summarized and compared to published recommendations. Results Preoperative NPO times were greater than recommended in 70% of patients studied (n = 37). Median time spent NPO preoperatively was not significantly different between complex (11.5 h) and non complex groups (10.8 h). Postoperative NPO time was significantly greater for complex procedures than for non complex. Most patients received some postoperative NPO time, even when it was not included in the physician diet order. Conclusion Observed preoperative NPO time exceeded current recommendations in this study.