Peer-reviewed article
Impact of an unrestricted clear liquid fasting protocol on pediatric perioperative outcomes: a prospective interventional study.
Mina AS, Gomez D, Nguyen DT, Kynes JM, Axt J ·
Summary
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Abstract
Purpose Traditional preoperative fasting guidance (6-4-2) aims to reduce aspiration risk but frequently produces prolonged fasting and discomfort in children. We evaluated whether progressively liberalizing the clear-liquid fasting policy reduces fasting time and improves the perioperative experience. Methods We conducted a prospective, four-phase interventional quality-improvement study at a tertiary hospital in rural Kenya (11/2021-12/2022). Phase 0 followed standard 6-4-2 guidelines; Phase 1 shortened clear-liquid fasting to 1 h; Phase 2 permitted a fixed volume of water until transfer to theatre; Phase 3, unrestricted water. The primary outcome was clear-liquid fasting time. Secondary outcomes were thirst, hunger, parental satisfaction, preoperative anxiety, and aspiration events. Results Among 253 children, median clear-liquid fasting time decreased: 14.0 h (Phase 0) to 1.7 h (Phase 3) (p < 0.001). Anxiety decreased significantly (mYPAS 35.4 to 22.9; p < 0.001) and thirst declined. Parental satisfaction was higher but did not reach statistical significance (8.0 to 9.0; p = 0.06). One confirmed aspiration occurred in Phase 1 (7.2-h fasting time). Conclusion Reducing preoperative fasting improved comfort and lowered anxiety. No increase in clinically significant aspiration events was observed, although the study was not powered for rare events. An unrestricted clear-liquid protocol appears feasible and beneficial.