Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved?
Background The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes f...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Society of Anesthesiologists
2021-07-01
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| Series: | Anesthesia and Pain Medicine |
| Subjects: | |
| Online Access: | http://www.anesth-pain-med.org/upload/pdf/apm-21025.pdf |
| _version_ | 1797825405206396928 |
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| author | Alexander R. Schmidt James Fehr Janice Man Genevieve D’Souza Ellen Wang Rebecca Claure Julianne Mendoza |
| author_facet | Alexander R. Schmidt James Fehr Janice Man Genevieve D’Souza Ellen Wang Rebecca Claure Julianne Mendoza |
| author_sort | Alexander R. Schmidt |
| collection | DOAJ |
| description | Background The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes for prolonged NPO times with the aim to suggest improvement strategies by a newly founded fasting task force. Methods Data from all electronic anesthesia records from 2019 at our institution were reviewed for fasting times. Our NPO instructions follow American Society of Anesthesiology guidelines and are calculated based on the patient’s arrival time (90 min before operating room [OR] time). Primary outcome was the effective NPO time for clear liquids, secondary outcomes were incidence of delays and the parental compliance with the NPO instructions. Data are presented as median (interquartile range). Results In total 9,625 cases were included in the analysis. NPO time was documented in 72.1% with a median effective NPO time of 7:13 h (7:36). OR in room times were documented in 72.8%, 2,075 (29.5%; median time 0:10 h [0:21]) were earlier and 4,939 (70.5%; median time 0:29 h [0:54]) were later than scheduled. Parental NPO compliance showed a median deviation for clear liquid intake of 0:55 h (8:30). Conclusions This study revealed that effective NPO times were longer than current ASA guidelines. Contributing causes include case delays and parental non-compliance to NPO instructions. Thus, task force recommendations include change NPO instruction calculations to scheduled OR time versus arrival time, and encourage parents to give their child clear liquids at the instructed time. |
| first_indexed | 2024-03-13T10:53:33Z |
| format | Article |
| id | doaj.art-9e25642092604d44aeab927257a09e9e |
| institution | Directory Open Access Journal |
| issn | 1975-5171 2383-7977 |
| language | English |
| last_indexed | 2024-03-13T10:53:33Z |
| publishDate | 2021-07-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Anesthesia and Pain Medicine |
| spelling | doaj.art-9e25642092604d44aeab927257a09e9e2023-05-17T05:48:30ZengKorean Society of AnesthesiologistsAnesthesia and Pain Medicine1975-51712383-79772021-07-0116326627210.17085/apm.210251084Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved?Alexander R. Schmidt0James Fehr1Janice Man2Genevieve D’Souza3Ellen Wang4Rebecca Claure5Julianne Mendoza6 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USABackground The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes for prolonged NPO times with the aim to suggest improvement strategies by a newly founded fasting task force. Methods Data from all electronic anesthesia records from 2019 at our institution were reviewed for fasting times. Our NPO instructions follow American Society of Anesthesiology guidelines and are calculated based on the patient’s arrival time (90 min before operating room [OR] time). Primary outcome was the effective NPO time for clear liquids, secondary outcomes were incidence of delays and the parental compliance with the NPO instructions. Data are presented as median (interquartile range). Results In total 9,625 cases were included in the analysis. NPO time was documented in 72.1% with a median effective NPO time of 7:13 h (7:36). OR in room times were documented in 72.8%, 2,075 (29.5%; median time 0:10 h [0:21]) were earlier and 4,939 (70.5%; median time 0:29 h [0:54]) were later than scheduled. Parental NPO compliance showed a median deviation for clear liquid intake of 0:55 h (8:30). Conclusions This study revealed that effective NPO times were longer than current ASA guidelines. Contributing causes include case delays and parental non-compliance to NPO instructions. Thus, task force recommendations include change NPO instruction calculations to scheduled OR time versus arrival time, and encourage parents to give their child clear liquids at the instructed time.http://www.anesth-pain-med.org/upload/pdf/apm-21025.pdfanesthesiologyfastingquality improvementsurveys and questionnaires |
| spellingShingle | Alexander R. Schmidt James Fehr Janice Man Genevieve D’Souza Ellen Wang Rebecca Claure Julianne Mendoza Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved? Anesthesia and Pain Medicine anesthesiology fasting quality improvement surveys and questionnaires |
| title | Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved? |
| title_full | Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved? |
| title_fullStr | Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved? |
| title_full_unstemmed | Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved? |
| title_short | Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved? |
| title_sort | pre operative fasting times for clear liquids at a tertiary children s hospital what can be improved |
| topic | anesthesiology fasting quality improvement surveys and questionnaires |
| url | http://www.anesth-pain-med.org/upload/pdf/apm-21025.pdf |
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