Enhanced recovery after surgery strategy to shorten perioperative fasting in children undergoing non-gastrointestinal surgery: A prospective study

ARTICLE HIGHLIGHTS

Research background

Shortening the pre-operative fasting time and early introduction of postoperative oral nutrition are two important foci of ERAS. However, there exists a discrepancy between preoperative fasting guidelines and clinical practice. And postoperative oral nutrition lacks guidelines. In the current study, we shortened the pre- and post-operative fasting time, and improved the children' comfort.

Research motivation

The topic of our study was to set out perioperative fasting schedule which is suitable for clinical situations. We tried to estimate the start time of each operation as accurately as possible and provide a safe and feasible criterion to start early eating. The procedures and findings could facilitate the optimization of perioperative fasting strategies in other surgical departments, especially in China.

Research objectives

Our main objectives were to set out perioperative fasting schedule which is suitable for clinical situations. Through multi-disciplinary collaboration and information transformation, we optimized the fasting and clear fluid drinking process before non-gastrointestinal surgery in children ≥ 3 mo of age and applied the water swallow test to evaluate the postoperative swallowing function after recovery from anesthesia. We enriched the research data on perioperative fasting schedule.

Research methods

The ERAS group adopted an individualized pre-operative fasting protocol, and the estimated start time of the operation for each patient was calculated on the day before surgery according to the order of the surgical list (which was decided by the surgical team). Meanwhile, according to the information system, the progress of the surgical list was continuously monitored by the chief nurse or another staff member, so that the fasting times could be adjusted timely.

Research results

Our individualized fasting protocols help the ERAS group realize a shorter preoperative food fasting time, shorter time to postoperative feeding, and greater satisfaction. No children experienced perioperative aspiration. Although the order of the surgical list did not change in this study, the duration of the individual operations inevitably varied from the estimated values, particularly for surgery that was performed at a different department. Thus, we hope to establish a warning system to predict risk factors which may result in the suspension of surgery in the whole hospital.

Research conclusions

We innovatively proposed the water swallow test to evaluate the postoperative swallowing function after recovery from anesthesia.

Research perspectives

We hope to further increase the preoperative intake of clear fluid drinking and set out the most optimal cutoff in the future.