Bhatt M, et al. - The association between preprocedural fasting duration and the incidence of sedation-related adverse outcomes were investigated in a large sample of children. Researchers did not find an association between fasting duration and any type of adverse event in this study. The results obtained from the study did not support delaying sedation to meet established fasting guidelines.

Methods

• From July 2010 to February 2015, the researchers 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.
• Preprocedural fasting duration was the primary risk factor.
• Age, sex, American Society of Anesthesiologists classification, preprocedural and sedation medications, and procedure type were the secondary risk factors.
• Four outcomes were investigated:
  • Pulmonary aspiration
  • The occurrence of any adverse event
  • Serious adverse events
  • Vomiting.

Results

• In total, 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 studied.
• They observed that 2974 (48.1%) and 310 (5.0%) children did not meet American Society of Anesthesiologists fasting guidelines for solids and liquids, respectively.
• No cases of pulmonary aspiration was found.
• They found 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.
• According to the findings obtained, 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) as well as 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).