A new study led by CHEO has shown that if children need an emergency procedure that requires sedation, there is no need to delay the sedation to meet current fasting guidelines. Published today in JAMA Pediatrics, the study included children from six emergency departments across Canada and found that there was no link between the amount of time a child had fasted and the occurrence of an adverse event.

Approximately 1 out of every 100 children who visits an emergency department for care receives sedation for common procedures, such as setting fractures or treatment of complex cuts. This translates into about 25,000 emergency department sedations in Canadian children per year.

Many emergency departments delay procedures requiring sedation so that children meet fasting guidelines: 2 to 4 hours since last drinking and 6 to 8 hours since last eating solid food. These guidelines were developed by expert organisations, such as the American Society of Anesthesiologists, for patients sedated for planned elective procedures, but have been extended and applied to all sedations outside of the operating room. It was not clear whether these guidelines needed to be followed for emergency department procedures.

The research team wanted to answer the question of whether there is a link between not fasting and adverse events in children receiving sedation for emergency procedures. Data from close to 6,200 children were collected as part of this study, with 2,974 children not meeting the recommended amount of fasting time before needing to be sedated; this study represents the largest and most robust prospective emergency department procedural sedation cohort to date.

“Even when physicians waited longer to perform a procedure, and there was more time between when a child last ate or drank and the sedation, it didn’t lower the likelihood of a sedation-related adverse event.

There was no difference in the rate of adverse events in young patients when we compared those who hadn’t fasted before being sedated for a procedure and those who had met fasting guidelines,” said Dr. Maala Bhatt, lead author, director of Pediatric Emergency Research at CHEO, and assistant professor at the University of Ottawa. “We’ve shown that we can give children emergency procedures that require sedation without waiting and still keep them safe. By not having to delay a procedure requiring sedation, we can reduce worry for children, youth, and families and reduce the time they spend in the emergency department.”

Researchers anticipate that these results will inform a change in policy and practice on pediatric emergency department sedation.