PERIOPERATIVE FASTING IN CHILDREN - TIME FOR NEW GUIDELINES

Perioperative fasting aims at decreasing the incidence of gastric cont ent inhalation during anesthesia. Current knowledge concerning gastric emptying and the epidemiology of pulmonary aspiration authorizes hew perioperative fasting guidelines. If prolonged fasting does not guaren tee gastric emptyness at the induction of anesthesia, shortening preop erative fasting by allowing clear fluids two hours before surgery does not modify gastric content and does not increase the risk of gastric content aspiration while enhancing the patient confort by reduction of the fasting period. On the other hand, after surgery, the mandatory i ntake of water significantly increases the incidence of postoperative vomiting. Therefore new guidelines may be applied for children operate d in ambulatory surgery settings: 1) clear fluids may be allowed until 2-3 hours before operation, 10 ml . kg(-1), or even ad libitum for so me authors (by clear fluids one means water, tea, coffee, apple juice, syrup with water); 2) drinking is not absolutely necessary before dis charge from day care surgery unit and should be left to the child's ow n assessment.