Are you hungry? Are you thirsty? – fasting times in elective outpatient pediatric patients

OBJECTIVE: This study assessed the duration of pre-operative fasting in children and its impact on the subjective feeling of hunger and thirst prior to elective outpatient anesthesia. BACKGROUND: Pediatric fasting guidelines are designed to reduce the risk of pulmonary aspiration of gastric contents during general anesthesia, and a fasting regimen of 6-8 h for solids, 4 h for breast milk, and 2 h for clear fluids is commonly used. Anecdotal evidence suggests that fasting times are often excessive. METHODS: A total of 1350 consecutive healthy children aged <16 (median 7.7, range 2-16) presenting for elective dental treatment under general anesthesia were enrolled in this prospective study. On hospital arrival, all children were asked when they last ate or drank and to rate their degree of hunger and thirst. RESULTS: The median (range) fasting times were 12:05 (00:45-21:50) hours and 07:57 (00:05-20:50) hours for solids and fluids, respectively. The majority of children were very hungry or starving (756/1350=56%), but less than a third of all children were very thirsty (361/1350=27%). Duration of solid food fast and severity of hunger correlated for patients fasted from before midnight (r=0.92) but not for food after midnight. No correlation was found for fluid intake and perception of thirst. CONCLUSION: This study shows that children presenting for elective outpatient surgery are suffering from a considerable amount of pre-operative discomfort because of excessive fasting. Strategies to guarantee minimal fasting at hospital admission are urgently needed.