SLR - April 2010 - Joshua Faley
Reference:
Yurtcu, M. et al. (2009). Effects of fasting and preoperative feeding in children. World Journal of Gastroenterology, 15(39), 4912-4922.
Scientific Literature Reviews
Reviewed by: Joshua Faley, DPM
Residency Program: Detroit Medical Center
Podiatric Relevance:
Numerous podiatric surgeons operate on pediatric patients, but there is limited literature available on preoperative fasting in comparison to adults. When given free intake of water up to 3 hours before surgery, thirst and anxiety are reduced in comparison with overnight fasting.
Methods:
This study design consists of a randomized, single-blind clinical trial. The study population consisted of 80 patients (range 1-10 years) with inguinoscrotal disorders. Tracheal intubation was planned in all cases with general anesthesia. Eight groups were designed with 10 patients who were fed normal liquid food (NLF) and high calorie diet (HCD) fed 2,3,4 and 5 hours before surgery. Residue was measured in the stomach with a Levin gastric tube after adequate and stable anesthesia was achieved. Gastric residue was measured by gentle aspiration with a 60-mL syringe. Blood levels were drawn when oral feeding was stopped and before operation measuring blood glucose, prealbumin, cortisol. Power was calculated as 100% with sample size of 10 patients in each group. Biochemical analysis was used to compare postprandial and starvation values.
Results:
Postprandial blood glucose levels were significantly lower compared to the fasting blood glucose levels, except for the HCD 4 hour preop. No significant difference between blood prealbumin was found within the groups. Postprandial blood cortisol levels in NLF-2, HCD-2, NLF-, NLF-5, and HCD-5 groups were significantly lower compared to fasting blood glucose levels. All patients stomach residue liquids were at tolerable levels.
Conclusions:
Preoperative fasting before elective surgery has become mainstay due to the risk of aspiration of stomach contents during anesthesia. This study has shown that the ingestion of free unlimited clear fluids by healthy 2-12 year-old children up to 2 hours prior to surgery does not affect gastric content and also does not alter gastric fluid pH or volume in comparison to fasting up to 6 hours. There is no need for more than 2 hours of fasting before (inguinoscrotal) surgery. Further studies need to be done to extrapolate these findings with orthopedic and podiatric procedures.