Preoperative fasting in children Recommended procedure of the European Society for Anesthesiology and Intensive Care

Current clinical guidelines regarding fasting for pediatric patients have recommended a conservative regimen for many years, without major modifications in recent decades. However, current publications describe a liberal approach as one in which no increased rates of aspiration or regurgitation were noted in patients. The aim of this European Society of Anaesthesiology and Intensive Care (ESAIC) guideline, the first to focus exclusively on preoperative fasting in pediatric patients, is to provide comprehensive, evidence-based recommendations to assist clinicians, healthcare providers, patients and parents. Six main topics were selected for the literature review: studies comparing liberal and conservative regimens, the influence of food composition, the influence of comorbidities, the use of gastric ultrasound in clinical practice, the validation of the use of gastric ultrasound for monitoring the volume of gastric contents and gastric emptying, early postoperative nutrition. The search was carried out by a professional librarian in cooperation with the ESAIC working group. The main outcomes are the reduction of fasting time after intake of clear liquids to 1 hour before the procedure, after breastfeeding to 3 hours before the procedure and allowing early postoperative oral intake; with GRADE 1C/1B evidence. The available evidence points to the possible benefit of using gastric ultrasound for clinical decision-making, and further that a light breakfast can be well tolerated if its intake is controlled. Further research is needed in these areas, as well as a more detailed evaluation of the effect of individual patient-specific and therapy-related factors on gastric emptying. © 2024, The authors.