Don't Delay Procedural Sedation for Children to Meet Fasting Times!

Preprocedural fasting guidelines, developed by the American Society of Anesthesiologists (ASA) and American Academy of Pediatrics, include 2 hours fasting for clear liquids, 4 hours for breast milk, 6 hours for infant formula and light meals, and 8 hours for solids with meat or fatty foods. These recommendations are consensus based with little supporting evidence. In a planned secondary analysis of a prospective cohort study conducted in six Canadian pediatric emergency departments (EDs), investigators evaluated whether preprocedural fasting duration predicts sedation-related adverse outcomes among children (0–18 years of age) undergoing sedation for painful procedures.

Of 6183 children (median age, 8 years) enrolled over 5 years, 12% had any adverse events, including serious adverse events in 1% (apnea, laryngospasm, hypotension, bradycardia, complete airway obstruction, clinically apparent pulmonary aspiration, permanent neurologic injury, or death), and vomiting in 5% (rarely during sedation). There were no cases of pulmonary aspiration. Overall, 48% of children did not meet ASA fasting guidelines for solids and 5% did not meet guidelines for liquids. The odds of any adverse event, serious adverse event, or vomiting did not change significantly with each additional hour of fasting from either solids or liquids.