The effect of preoperative fasting on the water sectors of the body in the perioperative period in children
https://doi.org/10.24884/2078-5658-2024-21-3-17-25
Abstract
Introduction. Avoiding solid foods and liquids before surgery is a common practice in elective surgery in pediatric, however, there is a risk of dehydration.
The objective was to assess the distribution of fluid across the water sectors of the body in children according to the duration of refusal of food and liquids before elective surgery.
Materials and methods. A single-center prospective cohort study. 104 children were examined, the average age was 12.5 ± 3.7 years. Depending on the age, patients were divided into three groups: group I: 3–7 years old, group II: 7–12 years old and group III: 12–18 years old. In each group, taking into account the duration of preoperative refusal of food and fluid, there were two subgroups: subgroup I – less than 12 hours; subgroup II – more than 12 hours. The average fasting time was 13.3 ± 2.7 hours. The condition of the water sectors of the body was assessed 30 minutes before surgery, 30 minutes and 24 hours after surgery.
Results. Before the operation, the distribution of fluid across the water sectors in groups I and II, depending on the duration of fasting, did not differ; in group III, when fasting for more than 12 hours, all indicators were significantly lower. 30 minutes and 24 hours after the intervention, an increase in the volume of total water and extracellular fluid was observed, however, significant changes were only in group III (p < 0.05). In group III, when fasting for more than 12 hours before surgery, lower systolic BP values were observed (p < 0.05).
Conclusion. The duration of preoperative refusal of solid food and liquids in the range of 12–15 hours does not adversely affect the indicators of water metabolism and is not associated with arterial hypotension during the induction of anesthesia.
About the Authors
Yu. S. Aleksandrovich
Saint-Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Aleksandrovich Yuri S., Dr. of Sci. (Med.), Professor, Honored Scientist of the Russian Federation, Vice-Rector for Postgraduate, Additional Professional Education and Regional Health Development, Head of the Department of Anesthesiology, Intensive Care and Emergency Pediatrics of the Faculty of Postgraduate and Additional Professional Education
2, Litovskaya str., Saint Petersburg, 194100
K. V. Pshenisnov
Saint-Petersburg State Pediatric Medical UniversityTashkent Pediatric Medical Institute
Russian Federation
Russian Federation
Pshenisnov Konstantin V., Dr. of Sci. (Med.), Associate Professor, Professor of Anesthesiology, Intensive Care and Emergency Pediatrics of the Faculty of Postgraduate and Additional Professional Education
2, Litovskaya str., Saint Petersburg, 194100
Sh. Sh. Shorakhmedov
Tashkent Pediatric Medical Institute
Uzbekistan
Uzbekistan
Shorakhmedov Shoakmal Sh., Postgraduate Student of the Department of Anesthesiology, Intensive Care and Emergency Pediatrics of the Faculty of Postgraduate and Additional Professional Education, SaintPetersburg State Pediatric Medical University; Assistant of the Department of Anesthesiology, Intensive Care and Pediatric Anesthesiology, Intensive Care
223, Bagishamal str., Yunusabad region, Tashkent, 100140
G. P. Tihova
Petrozavodsk State University
Russian Federation
Russian Federation
Tihova Galina P., Research Fellow
33, Lenin str., Petrozavodsk, Republic of Karelia, 185910
References
1. Aleksandrovich Yu.S., Vorontsova N.Yu., Grebennikov V.А. rt al. Recommendations on infusion-transfusion therapy in children undergoing surgery. Messenger of anesthesiology and resuscitation, 2018, vol. 15, no. 2, pp. 68‒84. (In Russ.) DOI: 10.21292/2078-5658-2018-15-2-68-84.
2. Voroncov I.M., Mazurin A.V. Propedevtika detskih boleznej: uchebnik. SPb., «Foliant», 2010, 1008 p. (In Russ.) ISBN 978-5-93929-184-2.
3. Zajchik A.Sh., Churilov A.P. Patohimija (jendokrinno-metabolicheskie narushenija). SPb., «JeLBI-SPb», 2007, 768 p. (In Russ.) ISBN 978-5-93979-032-1.
4. Sulaimanova Z.D., Lazarev V.V., Tsypin L.E. et al. The fluids as starting infusion therapy in the early postoperative period in children: solution with succinate or malate. A prospective, randomized study. Annals of Critical Care, 2020, no. 3, pp. 129‒136. (In Russ.) DOI: 10.21320/1818-474X-2020-3-129-136.
5. Aroonpruksakul N., Punchuklang W., Kasikan K. et al. The actual duration of preoperative fasting in pediatric patients, and its effects on hunger and thirst: a prospective observational study. Transl Pediatr, 2023, vol. 12, no. 2, pp. 146‒154. DOI: 10.21037/tp-22-358.
6. Assen H.E., Hassen A.M., Abate A. et al. Preoperative fasting time and its association with hypoglycemia during anesthesia in pediatric patients undergoing elective procedures at tikur anbessa specialized hospital, Addis Ababa, Ethiopia. Biomed Res Int, 2021, vol. 14, pp. 9166603. DOI: 10.1155/2021/9166603.
7. Balkaya A.N., Yılmaz C., Baytar Ç. et al. Relationship between fasting times and emergence delirium in children undergoing magnetic resonance imaging under sedation. Medicina (Kaunas), 2022, vol. 58, no. 12, pp. 1861. DOI: 10.3390/medicina58121861.
8. Betti C., Busi I., Cortesi C. et al. Fluids and body composition during anesthesia in children and adolescents: A pilot study. Eur J Pediatr, 2024, vol. 183, pp. 2251–2256. DOI: 10.1007/s00431-024-05490-x.
9. Brunet-Wood K., Simons M., Evasiuk A. et al. Surgical fasting guidelines in children: Are we putting them into practice? J Pediatr Surg, 2016, vol. 51, no. 8, pp. 1298‒302. DOI: 10.1016/j.jpedsurg.2016.04.006.
10. Dasgupta I., Keane D., Lindley E. et al. Validating the use of bioimpedance spectroscopy for assessment of fluid status in children. Pediatr Nephrol, 2018, vol. 33, no. 9, pp. 1601‒1607. DOI: 10.1007/s00467-018-3971-x.
11. Dongare P.A., Bhaskar S.B., Harsoor S.S. et al. Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists. Indian J Anaesth, 2020, vol. 64, no. 7, pp. 556‒584. DOI: 10.4103/ija.IJA_735_20.
12. Frykholm P., Disma N., Andersson H. et al. Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol, 2022, vol. 39, no. 1, pp. 4‒25. DOI: 10.1097/EJA.0000000000001599.
13. Jacob M., Chappell D., Conzen P. et al. Blood volume is normal after pre-operative overnight fasting. Acta Anaesthesiol Scand, 2008, vol. 52, no. 4, pp. 522‒529. DOI: 10.1111/j.1399-6576.2008.01587.x.
14. Jewer J.K., Wong M.J., Bird S.J. et al. Supplemental perioperative intravenous crystalloids for postoperative nausea and vomiting. Cochrane Database Syst Rev, 2019, vol. 3, no. 3, pp. CD012212. DOI: 10.1002/14651858.CD012212.pub2.
15. Joshi G.P., Abdelmalak B.B., Weigel W.A. et al. 2023 American society of anesthesiologists practice guidelines for preoperative fasting: carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration-a modular update of the 2017 American society of anesthesiologists practice guidelines for preoperative fasting. Anesthesiology, 2023, vol. 138, no. 2, pp. 132‒151. DOI: 10.1097/ALN.0000000000004381.
16. Khanna P., Saini K., Sinha R. et al. Correlation between duration of preoperative fasting and emergence delirium in pediatric patients undergoing ophthalmic examination under anesthesia: a prospective observational study. Paediatr Anaesth, 2018, vol. 28, no. 6, pp. 547‒551. DOI: 10.1111/pan.13381.
17. Lee H., Kim J.T. Pediatric perioperative fluid management. Korean J Anesthesiol, 2023, vol. 76, no. 6, pp. 519‒530.
18. Schmidt A.R., Buehler P., Seglias L. et al. Gastric pH and residual volume after 1 and 2 h fasting time for clear fluids in children. Br J Anaesth, 2015, vol. 114, no. 3, pp. 477‒482. DOI: 10.1093/bja/aeu399.
19. Schmitz A., Kellenberger C.J., Lochbuehler N. et al. Effect of different quantities of a sugared clear fluid on gastric emptying and residual volume in children: a crossover study using magnetic resonance imaging. Br J Anaesth, 2012, vol. 108, no. 4, pp. 644‒647. DOI: 10.1093/bja/aer497.
20. Song I.K., Kim D.H., Kim E.H. et al. Efficacy of bioelectrical impedance analysis during the perioperative period in children. J Clin Monit Comput, 2017, vol. 31, no. 3, pp. 625‒630. DOI: 10.1007/s10877-016-9881-1.
21. Thomas M., Morrison C., Newton R. et al. Consensus statement on clear fluids fasting for elective pediatric general anesthesia. Paediatr Anaesth, 2018, vol. 28, no. 5, pp. 411‒414. DOI: 10.1111/pan.13370.
22. Tsukamoto M., Hirokawa J., Yokoyama T. Intraoperative fluid management in pediatric patients using bioelectrical impedance analysis during oral surgery. Pediatric Anesthesia and Critical Care Journal, 2017, vol. 5, no. 2, pp. 81‒85. DOI: 10.14587/paccj.2017.13.
23. Хrykholm P., Schindler E., Sümpelmann R. et al. M. Preoperative fasting in children: review of existing guidelines and recent developments. Br J Anaesth, 2018, vol. 120, no. 3, pp. 469‒474. DOI: 10.1016/j.bja.2017.11.080.
24. Van Eyck A., Ledeganck K.J., Vermeiren E. et al. Body composition helps to elucidate the different origins of low serum magnesium in children with obesity compared to children with type 1 diabetes. Eur J Pediatr, 2023, vol. 182, no. 8, pp. 3743‒3753. DOI: 10.1007/s00431-023-05046-5.
25. Zhang E., Hauser N., Sommerfield A. et al. A review of pediatric fasting guidelines and strategies to help children manage preoperative fasting. Paediatric Anaesthesia, 2023, vol. 33, no. 12, pp. 1012‒1019. DOI: 10.1111/pan.14738.
Review
For citations:
Aleksandrovich Yu.S., Pshenisnov K.V., Shorakhmedov Sh.Sh., Tihova G.P. The effect of preoperative fasting on the water sectors of the body in the perioperative period in children. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2024;21(3):17-25. (In Russ.) https://doi.org/10.24884/2078-5658-2024-21-3-17-25
Email this article 