Preoperative Fasting Against Complications in Children

Preoperative fasting before undergoing surgical procedures that necessitate the use of anesthesia is meant to minimize the severity of complications. These complications are usually associated with regurgitation and aspiration. The ASA task force published practice standards, which dictate preoperative fasting procedures. These guidelines have also been approved by the CAS. Fasting regimes should be varied so as to accommodate different categories of patients such as children and pre-existing health conditions. Emergent procedures should be considered after evaluating the risk of postponing surgery against the potential for aspiration and regurgitation. The quantity and type of meal ingested need to be considered before the fasting duration is ascertained.

Equipment

• Medical records
• Audio and visual recording devices
• Weighing scale
• Thermometer
• Stethoscope
• Sterile gloves
• Emergency drugs

Recommended Practice

Preparation of children for preoperative fasting prior to elective surgery procedures

• The child and the parent should be briefed on the fasting regime that the patient will be placed under. It is important for the child and the parent to be informed of the significance of preoperative fasting before and during the surgery.
• The nurses preparing the child for preoperative fasting should build a good rapport with the patient and the patients.
• A medical background of the child should be obtained which should include history of allergies to particular drugs and foodstuffs.
• Obtain information about the dietary preferences of the child. This will be helpful when determining the appropriate fasting regime.
• Consult with an anesthetic specialist about the medical status of the patient.
• Plan for a fasting regime.

Procedures

Receive the patient when he/she arrives at the health facility. Make sure that the medical history of the child is obtained. This should include information about previous illness and other medical conditions.

1. Direct the child and the parent to the counseling room and make sure that they are comfortable. At this point the nurse should build a good rapport with the child and the parent.
2. Explain to the child and the parent why the patient has to be placed on a preoperative fasting regime. The nurse should emphasize on the significance of preoperative fasting regimes before and during the surgery. The nurse should be specific about the types of food that the child will be allowed to ingest and at what particular time.
3. The nurse should then proceed to obtain an informed consent from the parent before the child’s vitals such as; blood pressure, blood sugar levels, weight, and pulse among others are taken.
4. The child is then admitted and allocated bed space in the ward. Make sure to make arrangements for the parent to be allowed to accompany the child to the ward.
5. After the child is settled in the ward, the nurse can proceed to determine a fasting regime based on the time the surgery is scheduled. At this time it is good to consult the anesthetic specialist and also confirm the time the surgery is to take place. This will avoid subjecting the patient to a long fasting period.
6. Solid food should not be administered to the patient as at least 8 hours before surgery. Fried or meals containing a lot of fats will extend gastric release periods. Light meals such as clear fluids and slices of bread can be ingested 6 hours before surgery.
7. For infants being breast feed on milk, they can breastfeed up to 4 hours before surgery. Infants feed on milk formulas are allowed to ingest milk 6 hours before surgical procedures. Clear fluids can be ingested 2 hours before surgical procedures.
8. For surgical operations scheduled in the afternoon, patients may be given a light breakfast meal. This is comprised of a slice of bread without butter or porridge.
9. No oral fluid should be ingested 2 hours before the surgical procedure with the exception of premeditations only.
10. Intravenous fluids can be administered during fasting in the vent that the specific time for the surgery is unpredictable.
11. Ensure the patient is ready for surgery by confirming if it is still scheduled or postponed.
12. Hand over the patient with the medical records to the anesthetic team for surgery.
13. Prepare a post-operative dietary regime and prepare the patient for discharge after the operation.
14. Offer advice to the patient’s parent about the feeding regime of the patient after surgery.

Evidence Summary

For the evidence summary please refer to the reference page.

References

Brady M, Kinn S, Ness V, O’Rourke K, Randhawa N, Stuart P. Preoperative fasting for preventing perioperative complications in children. The Cochrane Database of Systematic Reviews [serial on the Internet]. (2009); 14(4):38-51.

Robertson-Malt S, Winters A, Ewing S, Jackson D, Kiame G. Preoperative fasting for preventing perioperative complications in children. Australian Nursing Journal [serial on the Internet]. (2008),; 15(9):29-31.

Klemetti S, Kinnunen I, Suominen T, Antila H, Vahlberg T, Leino-Kilpi H, et al. The effect of preoperative nutritional face-to-face counseling about child’s fasting on parental knowledge, preoperative need-for-information, and anxiety, in pediatric ambulatory tonsillectomy. Patient Education & Counseling [serial on the Internet]. (2010); 80(1):64-70.

Klemetti S, Suominen T. Fasting in paediatric ambulatory surgery. International Journal of Nursing Practice [serial on the Internet]. (2008); 14(1):47-56.

Klemetti S, Kinnunen I, Suominen T, Antila H, Vahlberg T, Leino-Kilpi H, et al. The effect of preoperative fasting on postoperative thirst, hunger and oral intake in paediatric ambulatory tonsillectomy. Journal of Clinical Nursing [serial on the Internet]. (2010); 19(3-4):341-350.

Dock-Nascimento D B, Aguilar-Nascimento J E D, Caporossi C, Magalhães M S, Faria R, Caporossi F S, & Waitzberg D L. Safety of oral glutamine in the abbreviation of preoperative fasting; a double-blind, controlled, randomized clinical trial. Nutr Hosp. 2011; 26(1):86-90.

Schricker T, Meterissian S, Lattermann R, Adegoke O A, Marliss E B, Mazza L, & Wykes L. Anticatabolic effects of avoiding preoperative fasting by intravenous hypocaloric nutrition: a randomized clinical trial. Annals of surgery. 2008; 248(6): 1051-1059.

Klemetti S, Kinnunen I, Suominen T, Antila H, Vahlberg T, Grenman R, & Leino-Kilpi H. The effect of preoperative fasting on postoperative pain, nausea and vomiting in pediatric ambulatory tonsillectomy. International journal of pediatric otorhinolaryngology. 2009; 73(2):263-273.

Yurtcu M, Gunel E, Sahin T K, & Sivrikaya A. Effects of fasting and preoperative feeding in children. World journal of gastroenterology: WJG. 2009; 15(39):4919.

Shabana A M, Ghanem M A, Elsarraf W M R. Preoperative fasting regimen for clear fluids in healthy children, changing perspective. A randomized controlled single blinded study. Egyptian Journal of Anaesthesia. 2009; 25(2):83-86.

Kaška M, Grosmanová, T Á, Havel E, Hyšpler R, Petrová Z, Brtko, M & Sluka, M. The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery–a randomized controlled trial. Wiener klinische Wochenschrift. 2010; 122(1-2):23-30.

Faria M S, de Aguilar-Nascimento J E, Pimenta O S, Alvarenga Jr L C, Dock-Nascimento D B & Slhessarenko N. Preoperative fasting of 2 hours minimizes insulin resistance and organic response to trauma after video-cholecystectomy: a randomized, controlled, clinical trial. World journal of surgery. 2009; 33(6):1158-1164.

Bopp C, Hofer S, Klein A, Weigand M A, Martin E & Gust R. A liberal preoperative fasting regimen improves patient comfort and satisfaction with anesthesia care in day-stay minor surgery. Minerva anestesiologica. 2011; 77(7):680-682.

Meisner M, Ernhofer U & Schmidt J. Liberalisation of preoperative fasting guidelines: effects on patient comfort and clinical practicability during elective laparoscopic surgery of the lower abdomen. Zentralblatt für Chirurgie. 2008; 133(05):479-485.

Klemetti S, Kinnunen I, Suominen T, Antila H, Vahlberg T, Leino-Kilp H, et al. Active preoperative nutrition is safely implemented by the parents in pediatric ambulatory tonsillectomy. Ambulatory Surgery [serial on the Internet]. 2010; 16(3):75-79.