Introduction Children, like adults, are required to fast before general anaesthesia to reduce the volume and acidity of stomach contents. Prolonged fasting can have significant physiological and psychological effects on children. Current guidelines suggest children should fast preoperatively for 6 and 2 h with regard to food and clear fluids respectively.1Control over operative and therefore fasting times for emergency surgery can be challenging. This audit aimed to compare local practice to fasting guidelines with respect to paediatric emergency appendicectomy.
Method This audit is a retrospective review of children between 5–16 years of age undergoing emergency appendicectomy from April 2013 to April 2014 in our District General Hospital. A standard was set for fasting of 6–7 h for food and 2–2.5 h for clear fluids.
Results 46 paediatric patients underwent an emergency appendicectomy in the audit period, one of which had to be excluded due to poor documentation. Patients ranged from 5–15 years, with an average age of 11 years. The average starvation for food was 11 h 49 min, with 29% of patients reaching the target (6–7 h). The average time for starvation for clear fluids was 8 h 48 min, with only 2% of patients reaching the target (2–2.5 h). The documentation around the administration of IV fluids was so poor that it had to be excluded.
Conclusion Patients were inappropriately starved preoperatively, with only 29% and 2% of patients meeting current guidelines with regards to food and clear fluids. This is unlikely to be specific to our hospital and so should prompt a review of the delivery of emergency services. Both our general surgical and anaesthetic departments are currently looking into educating all members of the team regarding feeding times and the introduction of preoperative drinks.
Disclosure of interest None Declared.
Brady MC, Kinn S, Ness V, O’Rourke, Randhawa N, Stuart P. Preoperative fasting for preventing perioperative complications in children (Review). Cochrane Database Syst. Rev. 2009;(4)