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Am J Emerg Med. 2018 Sep;36(9):1577-1580. doi: 10.1016/j.ajem.2018.01.033. Epub 2018 Jan 9.

Shortened preprocedural fasting in the pediatric emergency department.

Author information

1
Department of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, TX, United States. Electronic address: cechumpi@texaschildrens.org.
2
Department of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, TX, United States.
3
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
4
Texas Children's Hospital, Houston, TX, United States.
5
Austin Regional Clinic, Austin, TX, United States.

Abstract

BACKGROUND:

There is no evidence of an association between fasting time and the incidence of adverse events during procedural sedation and analgesia. Pediatric and adult emergency medicine guidelines support avoiding delaying procedures based on fasting time. General pediatric guidelines outside emergent care settings continue to be vague and do not support a set fasting period for urgent and emergent procedures.

OBJECTIVE:

To describe shortened preprocedural fasting and vomiting event rates during the implementation of a shortened fasting protocol.

METHODS:

This was a prospective study of patients undergoing procedural sedation and analgesia (PSA) in an urban, tertiary care children's hospital emergency center from March 2010-February 2012. All consecutive patients had documentation of preprocedural fasting time and adverse events recorded on a standardized data collection form.

RESULTS:

PSA occurred in 2426 patients with fasting data available for 2188 (90.2%); 1472 were fasted ≥6 h for solids and 716 patients were in the shortened fasting group (<6 h). There is no evidence of an association between emesis at any time and shortened fasting time unadjusted (OR = 1.18 (95% CI 0.75-1.84) or adjusted for known risk factors including age >12 years, initial ketamine dose >2.5 mg/kg or total dose >5.0 mg/kg (OR = 1.14 (95% CI 0.74-1.75).

CONCLUSION:

Analysis of a large prospective cohort study failed to find evidence of an association between emesis and shortened fasting time upon implementation of a shortened fasting protocol for procedural sedation and analgesia.

PMID:
29395760
DOI:
10.1016/j.ajem.2018.01.033

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