The Impact of Paediatric Perioperative Fasting on Intraoperative Parameters and Postoperative Period Quality

Introduction: In 2022, European guidelines updated fasting recommendations to a 1-3-6-hour rule to reduce fasting durations in pediatric patients submitted to anaesthesia. Aim: Our main goal was to confirm the duration of pediatric preoperative fasting, evaluating its impact on perioperative variables. Methods: Prospective, observational single-centre study, including all consecutive pediatric patients scheduled for elective surgeries during two months. Data were collected perioperatively and follow up was made until 24h postoperative. The impact of fasting duration was evaluated specifically in glycemia, heart rate and blood pressure. Results: One hundred and ninety sixt children were included. Median fasting periods for clear fluids and solids were 9,48 and 11,08 hours, respectively. The median time for fluid reintroduction after surgery was 2,00 hours, whereas for solids was 2,60 hours. Median duration of fasting and reintroduction of oral intake was significantly longer in patients submitted to surgery in the morning (p<0.001). Systolic blood pressure variation at the beginning of anesthesia was negatively correlated with fasting times for solids (p=0,043). Systolic blood pressure at the beginning of anesthesia was statistically lower in the morning (p=0,009). Glycemia had no significant relationship with fasting times and it was significantly higher in the morning (p=0,001). Both systolic and mean blood pressure variations were significantly lower in patients who fasted for solids for more than 10 hours (p=0,009 and p=0,004, respectively). Conclusions: Fasting times for paediatric patients submitted to surgical procedures at our hospital largely surpass currently endorsed timings. Solid fasting duration appears to have significant impact on systolic and mean blood pressure, with longer fasting durations being related to the occurrence of hypotension