CHANGING PARADIGMS IN PREOPERATIVE FASTING: RESULTS OF A JOINT EFFORT IN PEDIATRIC SURGERY

Preoperative Oral Carbohydrates for Children: A Meta-Analysis and Systematic Review

Background: Many studies have reported the use of preoperative oral carbohydrates (CHO) in children, but the results are inconsistent. The aim of this meta-analysis is to assess the effectiveness and safety of oral CHO administration in children prior to surgery, with the goal of offering a dependable reference for clinical nursing practices and surgical interventions. Methods: Two authors searched PubMed, Clinical trials, Web of Science, Embase, Cochrane Library, China national knowledge infrastructure (CNKI), Wanfang and Weipu databases for randomized controlled trial (RCT) on the effects of preoperative oral CHO in children up to April 12, 2024. We used RevMan 5.4 software for data analysis. Results: Nine RCTs involving a total of 1279 children were included. The meta-analysis showed that there was statistical difference in the pH of gastric juice (MD = 1.54, 95%CI: 1.40-1.67, p < .001), intraoperative sedation score (MD = 0.62, 95%CI: 0.27-0.97, p < .001), and the incidence of postoperative nausea and vomiting (OR = 0.40, 95%CI: 0.20-0.80, p = .009) between the CHO and control groups. There was no statistical difference in the RGV (MD = -0.23, 95%CI: -0.47-0.01, p = .06) and the postoperative blood glucose level (MD = -0.91, 95%CI: -5.03-3.21, p = .67) between the CHO and control groups. Egger regression analysis showed that there were no publication biases amongst the synthesized outcomes (all p > .05). Conclusion: The administration of oral CHO to children before surgery is safe and practicable. There is a need for additional, well-conducted studies with more participants to further elucidate the role of preoperative CHO administration.

Interventions to optimise preoperative fasting in paediatrics: a scoping review

BACKGROUND

Preoperative fasting is the standard of care for patients undergoing a procedure under general anaesthesia. Despite the increased leniency of fasting guideline recommendations, prolonged preoperative fasting periods continue to disproportionally affect paediatric patients. This review maps existing interventions optimising paediatric fasting practices, to explore strategies that can be best applied in clinical practice.

METHODS

A search strategy applied to PubMed, CINAHL, Embase, Scopus, and the Cochrane Database involved four key concepts: (1) fasting, (2) preoperative, (3) paediatric, and (4) quality improvement intervention. The Preferred Reporting Items of Systematic Reviews and Meta-analyses extension for Scoping Reviews was utilised in this review.

RESULTS

Thirteen heterogeneous studies, involving approximately 31 000 children across five continents, were included. Each intervention studied fell into at least one of the following six themes: (1) change in facility protocol, (2) technology-based intervention, (3) individualised fasting programs, (4) processes to improve communication between clinicians, (5) processes to improve communication to parents and families, and (6) staff education.

CONCLUSIONS

A variety of interventions have been studied to optimise paediatric preoperative fasting duration. These interventions show potential in reducing preoperative fasting duration.

ACERTO Project - 15 years changing perioperative care in Brazil

The ACERTO project is a multimodal perioperative care protocol. Implemented in 2005, the project in the last 15 years has disseminated the idea of a modern perioperative care protocol, based on evidence and with interdisciplinary team work. Dozens of published studies, using the protocol, have shown benefits such as reduced hospital stay, postoperative complications and hospital costs. Disseminated in Brazil, the project is supported by the Brazilian College of Surgeons and the Brazilian Society of Parenteral and Enteral Nutrition, among others. This article compiles publications by the authors who belong to the CNPq research group "Acerto em Nutrição e Cirurgia", refers to the experience of other national authors in various surgical specialties, and finally outlines the evolution of the ACERTO project in the timeline.

Elaboration, validation and reliability of the safety protocol for pediatric thirst management

Objective:

to elaborate, validate and evaluate the reliability of the Safety Protocol for Pediatric Thirst Management in the immediate postoperative period.

Method:

methodological quantitative research, based on the assumptions on measurement instrument development. The protocol was elaborated after literature review, interview with specialists and observation of the child’s anesthetic recovery. The judges performed theoretical validation through apparent, semantic and content analysis. Content Validity Index was calculated for content validation, whose minimum established concordance was 0.80. Protocol’s reliability was evaluated in children between three and 12 years old in the Post Anesthesia Care Unit.

Results:

in its final version, the protocol consisted of five evaluation criteria: level of consciousness, movement, airway protection, breathing pattern and nausea and vomiting. It presented easy comprehension and relevant content, and all indexes exceeded the minimum agreement of 0.80. Pairs of nurses applied the protocol 116 times to 58 children, resulting in a high reliability index (kappa general = 0.98)

Conclusion:

the unprecedented protocol developed is valid and is a useful tool for use in anesthetic recovery, aiming to assess safety for reducing the thirst of infant patients.

Metabolic and Inflammatory Benefits of Reducing Preoperative Fasting Time in Pediatric Surgery

OBJECTIVE

To investigate the metabolic/inflammatory impact of reducing the preoperative fasting time in preschool children.

METHODS

Forty children were randomly assigned to a fasting group (absolute fasting after 00:00) and a carbohydrate (CHO) group (allowed to ingest, two hours before surgery, a carbohydrate-rich beverage). Blood samples were collected right before and after surgery to quantify the levels of albumin, interleukin-6, glucose, insulin, C-reactive protein and to calculate insulin resistance by the HOMA-IR index.

RESULTS

Preoperative fasting time in the CHO group were shorter than in the fasting group (2.49h vs. 11.24h, p <0.001). Pre- and post-surgical CRP levels were significantly lower in the CHO group (p = 0.05 and p = 0.02, respectively). The preoperative CRP/albumin ratios in the CHO group were lower than in the fasting group (p = 0.03). Four patients (21%) in the fasting group but none in the CHO group were hyperglycemic before surgery (p = 0.04). The two groups had similar levels of albumin, interleukin-6, insulin and HOMA index. There were no adverse events.

CONCLUSION

Reducing the preoperative fasting time with carbohydrate-rich beverages improves the perioperative metabolic and inflammatory responses of preschool children undergoing inguinal hernia surgery.

Effects of an Individualized Fasting Program on Fasting Time and Comfort in Infants and Young Children During the Perioperative Period

PURPOSE

The study was designed to evaluate the effect of an individualized fasting program on fasting time and comfort in infants and young children during the perioperative period.

DESIGN

A quasiexperimental design was used.

METHODS

The study included 675 children (intervention = 353, control = 322). Data collection tools included Characteristics of Children Form and the Infant Hunger Rating Scale. The fasting program included individualized fasting education and fasting in batches. On the day of the operation, clear liquids were fed 2 hours before surgery and refed after the patient woke after surgery.

FINDINGS

The duration of perioperative fasting and the time to refeeding were shorter, the hunger scores were lower in the intervention group than those in the control group (P < .05). There was no difference in the incidence of vomiting between the two groups (P > .05), and no coughing and bloating occurred.

CONCLUSIONS

The fasting program for infants and young children can shorten the duration of fasting and can reduce the degree of hunger. This program is safe and feasible.