The times, they are a-changing – Bob Dylan
- Site of project: Uppsala University Hospital, Uppsala, Sweden
- The most widely practiced regimen for fasting in children: 6-4-2 (in hours for solids and milk- breast milk-clear fluids respectively), but does it actually translate into 6-4-2 in practice – especially for clear fluids?
- What are the reasons for poor compliance?
- The main operating theatres in Uppsala have been running 6-4-0 since the year 2000
- A separate operating unit (ENT, plastics, oral surgery) wanted to trial the 6-4-0 regime
Materials and Methods:
- All patients 16 years of age and younger, having elective procedures were included
- Nurse and parents were questioned in the anaesthetic room
- 6-4-0 regimen: Patients were allowed clear fluids till the time of being called for theatre
- Individual assessments to avoid 6-4-0 rule as deemed necessary
- The study included 203 patients in total, divided into three groups:
- ENT6-4-2: patients having their operation in the ENT unit with the 6-4-2 rule, before the introduction of 6-4-0 (66 children)
- ENT6-4-0: patients having their operation in the ENT after the introduction of 6-4-0 (64 children)
- MP6-4-0: patients having their operation in main theatres, which has been running 6-4-0 since the year 2000 (70 children)
- Outcome measures: Actual total fluid fasting times
- Information about fasting times was provided by Preassessment nurse, Paediatric anaesthetists and/or Surgeons, based on Medical records and sometimes given over the phone.
- There was a significant improvement in fasting times after introduction of the 6-4-0 regimen
- The MP6-4-0 median fasting time was longer than ENT6-4-0
- This could be due to different type of patients, different surgical or medical complexity and different proportions of inpatients (MP 50% vs ENT 80%)
- The identified reasons for failure were:
- Tradition, Rearrangements of surgery list schedules among others.
- Why are younger children suffering more?
- Breast milk fed (4 hour starvation), over-zealous parents/carers, first on the list.
- Fear of risk of pulmonary aspiration: incidence of 1 to 10 in 10,000 was not increased with 6-4-0
- Gastric volume and pH is unaffected by fluid ingestion 1-2 hours prior
- The half-time for gastric emptying of clear fluids is 10-27 min
- There was no pulmonary aspiration in this study but it’s not powered to detect this
- Individual assessment is advised
Summary by Dr Prakash Krishnan