Does the duration of preprocedural fasting alter the risk pulmonary aspiration and associated adverse outcomes in children undergoing emergency department procedural sedation?
In this study of 6183 healthy patients undergoing sedation in 1 of 6 geographically separate and nationally representative Canadian emergency departments, 2974 (48.1%) did not meet fasting guidelines prior to sedation. Data analysis failed to identify an association between preprocedural fasting of any duration and any type of adverse event, and there were no cases of clinically apparent pulmonary aspiration.
Delaying sedation to meet established fasting guidelines appears not to improve sedation outcomes for children in the emergency department.
It is not clear whether adherence to preprocedural fasting guidelines prevent pulmonary aspiration and associated adverse outcomes during emergency department (ED) sedation of children.
To examine the association between preprocedural fasting duration and the incidence of sedation-related adverse outcomes in a large sample of children.
Design, Setting, and Participants
We conducted a planned secondary analysis of a multicenter prospective cohort study of children aged 0 to 18 years who received procedural sedation for a painful procedure in 6 Canadian pediatric EDs from July 2010 to February 2015. The primary risk factor was preprocedural fasting duration. Secondary risk factors were age, sex, American Society of Anesthesiologists classification, preprocedural and sedation medications, and procedure type.
Main Outcomes and Measures
Four outcomes were examined: (1) pulmonary aspiration, (2) the occurrence of any adverse event, (3) serious adverse events, and (4) vomiting.
A total of 6183 children with a median age of 8.0 years (interquartile range, 4.0-12.0 years), of whom 6166 (99.7%) had healthy or mild systemic disease (American Society of Anesthesiologists levels I or II), were included in the analysis. Of these, 2974 (48.1%) and 310 (5.0%) children did not meet American Society of Anesthesiologists fasting guidelines for solids and liquids, respectively. There were no cases of pulmonary aspiration. There were 717 adverse events (11.6%; 95% CI, 10.8%-12.4%), of which 68 (1.1%; 95% CI, 0.9%-1.3%) were serious adverse events and 315 (5.1%; 95% CI, 4.6%-5.7%) were vomiting. The odds ratio (OR) of occurrence of any adverse event, serious adverse events, and vomiting did not change significantly with each additional hour of fasting duration for both solids (any adverse event: OR, 1.00; 95% CI, 0.98 to 1.02; serious adverse events, OR, 1.01; 95% CI, 0.95-1.07; vomiting: OR, 1.00; 95% CI, 0.97-1.03) and liquids (any adverse event: OR, 1.00; 95% CI, 0.98-1.02; serious adverse events: 1.01, 95% CI, 0.95-1.07; vomiting: OR, 1.00; 95% CI, 0.96-1.03).
Conclusions and Relevance
In this study, there was no association between fasting duration and any type of adverse event. These findings do not support delaying sedation to meet established fasting guidelines.
Bhatt M, Johnson DW, Taljaard M, et al. Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children. JAMA Pediatr. 2018;172(7):678–685. doi:10.1001/jamapediatrics.2018.0830
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