This study examined how to decrease the fasting time for pediatric patients during the postoperative period. It was found that these patients often fast 2.5 times longer than necessary. This causes negative physiological affects as well as increased stress and discomfort for both patient and parents. The prolonged fasting time is due to lack of staff and parent education on the guidelines for fasting, schedule changes in the OR and surgeon concerns for patients eating too soon postoperatively. After an intervention of sugar water 2 hours prior to OR time as well as eating an hour after surgery they were able to decrease patient and parent discomfort and there were no increased incidence of aspiration.
Surgery on a child is traumatic enough without making the patient fast longer than they need to. According to the article I found they have been able to decrease time from 9 hours to 6 hours and have implemented sugar water to help with this timeline as well.
As a parent, this would have reduced my anxiety bringing my 2 year old in for surgery. He didn’t understand why he couldn’t eat or drink and was very difficult to console after he came out of recovery.
https://doi.org/10.1111/pan.13661
Sorry your little guy had to have surgery, that’s so hard to go through as a parent. I’m glad studies like this have found that we can make it easier on the kids and consequently their parents by something as simple as paying attention and not prolonging fasting times.
I find this topic very interesting. I work as a floor nurse on a pediatric acute care unit and this is commonly a problem. Mainly when surgeons are putting patients on the surgery schedule to follow another surgery this makes it hard to know what time the patient is actually going to surgery. Making patients NPO to soon or for to long can prolong there healing, nutrition is needed for healing. According to this article experts have researched this information. “Fasting from clear liquids is recommended for 2 hours before procedures for healthy children and adults undergoing elective procedures. With solid food, when fasting from
the intake of a light meal (toast and clear liquid), 6 hours is recommended. Fatty or fried foods may delay gastric emptying and therefore require a longer fasting period;
in these situations, 8 hours is recommended. For infants, the guidelines recommend fasting from infant formula for 6 hours and breast milk for 4 hours.
NPO for to long not only affects patients in the pediatric setting but for anyone who is getting surgery. This information should be provided not only to surgical providers but educated to parents. When I see an order for NPO at midnight I am always searching to see when the surgery is scheduled for. NPO status can change moods and behaviors and we want every happy and healthy.
Powers, J. (2017). Ask the Experts. Changing Guidelines for Preoperative Fasting. Critical Care Nurse, 37(1), 76–77. https://doi-org.ezproxy.fhsu.edu/10.4037/ccn2017424
Yes, NPO at midnight seems cruel and unusual after looking at the actual guidelines. Having worked in Pre-op/PACU for most of my career, I see the rationale behind it, but it is purely schedule driven. If a patient cancels or has to delay because they ate when they shouldn’t have it opens up a hole in the schedule and they want to fill it. So, keeping people NPO gives them flexibility. However, it seems rather inhumane especially for the littles. (It is detrimental for geriatric as well, but that’s another article) In the Pedi PACU I was in I wasn’t always aware of the NPO time preop, but as soon as a kid woke up (surgery permitting) we fed them. In my experience kids didn’t experience post op nausea like adults do.
I worked as a PACU nurse and helped frequently in Pre-op. When pediatrics were scheduled for routine surgeries they were scheduled based on age, with the youngest going first. This seemed to help with the long fasting times. I have not worked with a surgeon that put stipulations on eating after surgery. All of our surgeons wanted them to eat and drink something right away to make sure they were able to keep it down before they were discharged. I understand the frustration about the long fasting times prior to surgery but I would think there could be a happy medium somewhere. By scheduling based on youngest going first when at all possible this can help to prevent the excessive fasting times. I also know that the anesthesia and other medications administered during surgery play a big part on how the child reacts when they wake up. We had a couple CRNAs and an anesthesiologist that would administer extra meds during surgery and then would order demerol in PACU. The kids would wake up crying, we would give the demerol and they would fall back asleep then wake up calm. We got to the point we would always ask who was doing anesthesia because that would tell us how PACU was going to go. Do you think that anesthesia plays just as big of a role as the fasting times on how uncomfortable pediatrics are after surgery?
I think that’s an interesting fact about the Demerol and it’s use with calming pediatric patients post procedure. I found a link to a trial study they are using on pediatric dental patients….curious to see how that trial works out!
SmartPatients. Comparing Pediatric Dental Oral Sedation Outcomes With and Without Meperidine in Children Aged 3-7 Years. Smart Patients. https://www.smartpatients.com/trials/NCT04068948.
Demerol works wonders! At least in my experiences. For pediatric surgeries the anesthesiologist at our hospital uses the Demerol during surgery and usually the children wake up pretty calm.
Definintely, I do remember that you could always count on certain anesthesiologists kids to come out better than others. We were also a teaching hospital and had lots of residents coming through all the time. Right about July, when the new residents were getting to man their own cases you would see a difference. A lot of them seemed scared to give any meds, they were VERY conservative and this would mean a hard wake up. Over all though, kid seemed to wake up pretty well and being able to feed them ASAP made it so we didn’t need to give them as much narcotic in my opinion. At least for the small ones, since often all you can go on is the crying.
This is an interesting topic because I’ve never through about the effects of NPO orders on children, but I imagine it would be so much more traumatic than for an adult. (Our adult patients still seem to have issues with not eating before surgery too, of course!) I too looked up the health guidelines for NPO guidelines according to UCLA Anesthesiology and Peri-operative Medicine (2020), which shows the guidelines of the clears two hours before being okay. If fluids are not running, it is important for patients to stay hydrated before a procedure anyway. I think many RN’s use their own judgment when administering medications around NPO orders as well, since many orders are not clear/ appropriate. Maybe the hospitals need an updated NPO order set based on procedure that providers can look through and choose appropriate for the surgery and age population?
UCLA. (2020). When to Stop Eating and Drinking. UCLA Anesthesiology & Perioperative Medicine. https://www.uclahealth.org/anes/fasting-guidelines.
Yes, that would probably be helpful. As well as education for nurses on the floors and in periop. That way everyone can be on the same page.
This is so interesting as a parent I always fear the need for surgery in one of my kiddos and having to keep them from eating or drinking (milk is toddler life right now). Also interesting as I know of a case where a child did not eat/drink as directed and still aspirated. I feel there will always be cases like that though as not everyone digest as the same rate and some have slower than normal digestion. In Australia, a hospital allows for clear liquids up to 1 hour before surgery, which is a lot better than nothing for 6-8 hours.
Kids health information : Preparing your child for surgery – fasting. (2019, October). The Royal Children’s Hospital : The Royal Children’s Hospital. https://www.rch.org.au/kidsinfo/fact_sheets/Preparing_your_child_for_surgery_%E2%80%93_fasting/
This is an interesting topic. I have read an article on adults and NPO after midnight but I did not think about how this would be with peds patients. I can see how this could be frustrating for the patient and parents on trying to explain with holding food for so long on top of the fear of surgery. I never thought about scheduling and how that might play a role in why it is in most cases longer than it needs to be.