A retrospective review of periooperative fasting

This is a review of patient case notes by the care team with a view to examining current practice for peri-operative fasting for children having general anaesthesia for surgery, therapeutic treatments or diagnostics. Current guidelines for peri-operative fasting at great ormond street are 1 hour for clear fluids, 3 hours for breast milk and 6 hours for formula/ artificial feeding or solids. Children are fasted prior to surgery to reduce the risk of pulmonary aspiration of gastric contents. Evidence for the exact risk of pulmonary aspiration is historic and variable1,2. Nevertheless consensus fasting guidelines for children have been developed and adhered to for many years3. More recently studies have shown that institutional adherence to pre-operative fasting guidelines may result in the over fasting of children prior to general anaesthetic4. Overfasting, has been shown to have adverse effects, including hypoglycaemica on children.5 The primary aim of our study is to evaluate whether children are over-fasted relative to our current guidelines. Over the last 5 years approximately 60000 children have been fasted for elective surgery at GOSH and had their fasting times documented in the electronic healthcare record (EPIC). This provides us with the opportunity to look at peri-operative fasting times in one of the largest cohorts of surgical children in the world.