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PEDIATRIC ANESTHESIA

A Liberalized Fasting Guideline for Formula-Fed Infants Does Not Increase Average Gastric Fluid Volume Before Elective Surgery

Scott D. Cook-Sather, MD^*, Kathleen A. Harris, RN BSN^*, Rosetta Chiavacci, RN BSN^*, Paul R. Gallagher, MA, and Mark S. Schreiner, MD^*

Departments of *Anesthesiology and Critical Care Medicine and Pediatrics, Division of Biostatistics and Epidemiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

Address correspondence and reprint requests to Scott D. Cook-Sather, MD, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, 34th St. & Civic Ctr. Blvd., Philadelphia, PA 19104. Address e-mail to sather{at}email.chop.edu

Recommended preoperative fasting intervals for infant formula vary from 4 to 8 h. We conducted a prospective, randomized, observer-blinded trial of 97 ASA physical status I and II infants scheduled for elective surgery to determine whether average gastric fluid volume (GFV) recovered from infants formula-fasted for 4 h (liberalized fast, Group L) differed from that recovered from infants allowed clear liquids up until 2 h, but fasted 8 h for formula and solids (traditional fast, Group T). In Group L, 31 of 39 subjects followed protocol and ingested formula 4–6 h before surgery. In Group T, 36 of 58 subjects followed protocol, taking clear liquids 2–5 h before the induction of anesthesia. Thirty subjects had prolonged fasts and were included only in a secondary intent-to-treat analysis. Respective mean age (5.7 ± 2.3 versus 6.4 ± 2.4 mo; range, 0.7–10.5 mo), weight (7.5 ± 1.8 versus 7.5 ± 1.1 kg), and volume of last feed (4.9 ± 2.2 versus 4.0 ± 2.3 oz.) did not vary between Groups L and T. GFV (L: 0.19 ± 0.38 versus T: 0.16 ± 0.30 mL/kg) and gastric fluid pH (L: 2.5 ± 0.5 versus T: 2.9 ± 1.3) did not vary. For all subjects, GFV (mL/kg) increased with age (Spearman correlation coefficient = +0.23, P = 0.03). Infant irritability and hunger and parent satisfaction were similar between groups. We conclude that average GFV after either a 4- to 6-h fast for infant formula or 2-h fast after clear liquids is small and not significantly different between groups. On the basis of these findings, clinicians may consider liberalizing formula feedings to 4 h before surgery in selected infants.

IMPLICATIONS: Healthy infants aged 10.5 mo may drink formula up to 4 h before surgery without increasing gastric fluid volume compared with infants allowed clear liquids up to 2 h and formula 8 h before surgery.

This article has been cited by other articles:

				T. J. Mancuso How Long a Fast Before Elective Surgery? AAP Grand Rounds, November 1, 2003; 10(5): 58 - 59. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999