Preoperative fasting for elective surgery in children

This review investigated preoperative fasting in children who need elective surgical interventions. Fifty publications included in the abstract databases PubMed and elibrary for the period from 2017 to 2023 were reviewed. For the analysis, we used articles on the effect of preoperative fasting on indicators of the cardiovascular system and water and carbohydrate metabolism and assessed the course of the perioperative period depending on the duration of refusal of solid food and liquids before surgery. The article presents historical information that formed the basis for the modern paradigm of refusal of solid food and liquids in the preoperative period, especially the negative consequences of prolonged refusal of food in the preoperative period, indicating the main ones, namely, euglycemic ketosis and ketoacidosis, which are common in children. Hypoglycemia due to food refusal before surgery is rare and is not a serious problem in most patients, except in children in the first year of life. In most cases, it has been demonstrated that the time of preoperative fasting significantly exceeds the recommended intervals and amounts to more than 10 hours, and >75% of patients experience a strong feeling of hunger. Infusion of dextrose solutions has not been found to reduce feelings of hunger and thirst before surgery. An increase in preoperative fasting time is often associated with improper organization of the process (35.1%), an increase in surgical time (34.1%), and surgical plan changes (20.9%). It is noted that the optimal volume of liquid that a child can drink before surgery is <3 ml/kg. Data indicates that preoperative fasting can cause arterial hypotension after induction of anesthesia, at the stage of preparing the surgical field. It has been demonstrated that a residual gastric volume of >1.25 ml/kg is a risk factor for aspiration during the induction of anesthesia. There is currently no convincing evidence of the negative effect of preoperative fasting on treatment outcome; however, clearly, the time to abandon clear liquids before elective surgery in children should be minimal.