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1.
  • Frykholm, Peter, 1961-, et al. (author)
  • Preoperative fasting in children : review of existing guidelines and recent developments
  • 2018
  • In: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 120:3, s. 469-474
  • Research review (peer-reviewed)abstract
    • The current guidelines for preoperative fasting recommend intervals of 6, 4, and 2 h (6-4-2) of fasting for solids, breast milk, and clear fluids, respectively. The objective is to minimize the risk of pulmonary aspiration of gastric contents, but also to prevent unnecessarily long fasting intervals. Pulmonary aspiration is rare and associated with nearly no mortality in paediatric anaesthesia. The incidence may have decreased during the last decades, judging from several audits published recently. However, several reports of very long fasting intervals have also been published, in spite of the implementation of the 6-4-2 fasting regimens. In this review, we examine the physiological basis for various fasting recommendations, the temporal relationship between fluid intake and residual gastric content, and the pathophysiological effects of preoperative fasting, and review recent publications of various attempts to reduce the incidence of prolonged fasting in children. The pros and cons of the current guidelines will be addressed, and possible strategies for a future revision will be suggested.
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2.
  • Suempelmann, R., et al. (author)
  • Perioperative fasting times in children and adolescents
  • 2022
  • In: Anasthesiologie und Intensivmedizin. - : AKTIV DRUCK & VERLAG GMBH. - 0170-5334 .- 1439-0256. ; 63, s. 320-328
  • Journal article (peer-reviewed)abstract
    • The German Scientific Working Group for Paediatric Anaesthesia (Wissenschaftlicher Arbeitskreis Kinderansthesie, WAKKA) of the German Society for Anaesthesia and Intensive Care Medicine (DGAI) has updated their current recommendations on preoperative fasting in children from 2007, along with the preoperative fasting statement of the German Association of Anaesthesiologists (Berufsverband Deutscher Anasthesisten, BDA) and DGAI from 2016 in agreement with the new evidence-based European Guideline of the European Society of Anaesthesiology and Intensive Care (ESAIC) of 2022 - and transferred it into the S1 Guideline format of the Association of the Scientific. Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgeselischaften e. V., AWMF). This revision became necessary because recent studies had shown that optimized fasting times improved hornoeostasis and well-being of the children, while the risk of regurgitation and aspiration had not increased. On the other hand, long periods of fasting might be the cause of misbehaviour, stress, iatrogenic dehydration and catabolism. The updated S1 Guideline therefore recommends shorter fasting times of 4 hours for small, light meals and/or formula or cow's milk (still 6 hours for a full meal), 3 hours for breast milk, and 1 hour for clear fluids (6-4-3-1 Rule). In addition, the new S1 Guideline contains further recommendations for children with concomitant diseases that are of relevance to anaesthesia, for the application of ultrasound to examine the stomach content prior to the induction of anaesthesia, for postoperative fasting and the implementation of the new rules in clinical practice.
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