Like adults, children are often required to go without food or drink up to a half-day before surgery to prevent their stomach contents from being regurgitated or sucked into the lungs under general anesthesia.

In the review of 43 randomized controlled trials involving 2,350 children, only one case of regurgitation or aspiration of food or drink into the lungs was reported, according to Marian Brady of the Glasgow Caledonian University in Scotland and colleagues.

The review appears in the April issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

There is no evidence to suggest that children given liquids two hours before surgery have higher stomach volumes or more acidic stomach contents than those who undergo longer fasts, the researchers found. Stomach volume and acidity are two factors thought to influence the risk and severity of aspiration.

Although most research evidence now supports relaxed fasting standards, "kick-starting an evolution in fasting policies remains a difficult task," Brady says. She notes that some hospitals still require patients to eat or drink nothing after midnight the day of surgery, a "practice that should no longer be tolerated," she says.

"Most children can safely drink clear liquids until two hours before surgery, although more research is needed for some groups of children," Brady and colleagues write.

Not surprisingly, children allowed a drink closer to surgery said they were less hungry and thirsty and more comfortable. Physicians also reported that t
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Contact: Marian Brady
m.brady@gcal.ac.uk
Center for the Advancement of Health
27-Apr-2005