1 00:00:00,000 --> 00:00:13,480 There is nothing to shake up an OR schedule rather than a patient who ate two hours before 2 00:00:13,480 --> 00:00:14,480 their scheduled operation. 3 00:00:14,480 --> 00:00:17,280 But is the risk of aspiration real? 4 00:00:17,280 --> 00:00:21,320 How long do patients really need to fast before an operation? 5 00:00:21,320 --> 00:00:27,280 Lucky for us, Dr. Mary Edwards brings us up to speed on the latest data-driven recommendations. 6 00:00:27,280 --> 00:00:32,620 You are called at midnight from a community hospital with a level 2 NICU regarding your 7 00:00:32,620 --> 00:00:39,320 patient who is a 28-week preemie who is scheduled for a hernia repair at 7 in the morning. 8 00:00:39,320 --> 00:00:42,800 He's otherwise well and he's actually ready to go home. 9 00:00:42,800 --> 00:00:48,760 But the NICU has attempted to get an IV in him 10 times without success and they've had 10 00:00:48,760 --> 00:00:50,760 it and the kid has had it. 11 00:00:50,760 --> 00:00:52,800 They call you and they want to know what to do. 12 00:00:52,800 --> 00:00:57,840 You might say you should transfer that patient, but again, I think the evidence I know our 13 00:00:57,840 --> 00:01:04,760 anesthesiologists allow Pedialyte up to even an hour or two hours before the procedure. 14 00:01:04,760 --> 00:01:08,560 So there's no reason you can't continue with oral hydration with a baby like this prior 15 00:01:08,560 --> 00:01:09,900 to surgery. 16 00:01:09,900 --> 00:01:17,080 This subject is evolving and it is amazing to me how variable practices are around the 17 00:01:17,080 --> 00:01:18,200 world. 18 00:01:18,200 --> 00:01:25,140 I can briefly say NPO guidelines for children are in general based on very poor evidence. 19 00:01:25,140 --> 00:01:29,600 And if you do even a Google search, you'll find that from institution to institution, 20 00:01:29,600 --> 00:01:31,200 they vary a lot. 21 00:01:31,200 --> 00:01:36,280 The outcomes following aspiration can be severe, but it's a relatively rare event in elective 22 00:01:36,280 --> 00:01:38,080 surgery populations. 23 00:01:38,080 --> 00:01:42,480 High risk patients are really those that are coming in for emergency procedures. 24 00:01:42,480 --> 00:01:46,680 And the other thing is studies suggest that clear liquids containing carbohydrates empty 25 00:01:46,680 --> 00:01:48,760 the stomach very quickly. 26 00:01:48,760 --> 00:01:51,120 And that really doesn't vary based on age. 27 00:01:51,120 --> 00:01:54,760 One of the more recent consensus statements came out of Britain and Ireland, and they 28 00:01:54,760 --> 00:02:00,200 essentially recommend one hour of NPO for clear liquids, four hours for breast milk 29 00:02:00,200 --> 00:02:04,200 and six hours for solid foods and children under 17 years old. 30 00:02:04,200 --> 00:02:09,740 In the United States, the American Society of Anesthesiologists is updating their policy 31 00:02:09,740 --> 00:02:12,200 or their consensus statement on NPO guidelines. 32 00:02:12,200 --> 00:02:18,800 Currently, what they recommend is two hours for clear liquids, four hours for breast milk, 33 00:02:18,800 --> 00:02:23,760 six hours for non-human milk and light meals and eight hours for a heavy meal. 34 00:02:23,760 --> 00:02:28,240 The European Society of Anesthesia and Intensive Care is even more liberal than that. 35 00:02:28,240 --> 00:02:33,040 They recommend only one hour of NPO for clear liquids, three hours for breast milk, four 36 00:02:33,040 --> 00:02:36,440 hours for formula and six hours for all of their intake. 37 00:02:36,440 --> 00:02:40,920 These guidelines are those that are widely accepted in Australia and New Zealand as well. 38 00:02:40,920 --> 00:02:45,760 So things are moving in the direction of being more liberal. 39 00:02:45,760 --> 00:02:51,160 But I can tell you one thing about all these consensus statements is that there's now language 40 00:02:51,160 --> 00:02:56,520 in there that essentially says you need to make every effort not to keep these children 41 00:02:56,520 --> 00:02:59,600 NPO for long periods of time prior to surgery. 42 00:02:59,600 --> 00:03:00,600 It's bad. 43 00:03:00,600 --> 00:03:06,720 It generates ketone bodies, causes hypoglycemia, makes them just very irritable in the preop area. 44 00:03:06,720 --> 00:03:07,720 It's interesting. 45 00:03:07,720 --> 00:03:10,800 It's kind of aggravating that everyone does it different because it's confusing. 46 00:03:10,800 --> 00:03:14,800 But on the other hand, now maybe we can look at the differences and study that and see 47 00:03:14,800 --> 00:03:15,800 who does it better. 48 00:03:15,800 --> 00:03:19,920 Thanks for joining Dr. Edwards along with the rest of the ABSA Professional Development 49 00:03:19,920 --> 00:03:22,680 Committee for this update course rewind. 50 00:03:22,680 --> 00:03:26,880 And remember to check out the Stay Current app for more content related to pediatric 51 00:03:26,880 --> 00:03:38,520 surgery and more.