In recent years, the concept of accelerated recovery surgery has gained popularity, and reducing the duration of preoperative fasting and drinking is an important component of it. The traditional view is that surgical patients should be fasting sufficiently before anesthesia to allow adequate gastric emptying to avoid the risk of reflux aspiration during anesthesia. Therefore, it is traditionally recommended to fast for 12 hours and abstain from drinking for 6 hours before surgery. Several studies have suggested that prolonged preoperative fasting leads to poor preoperative experience, and water-electrolyte imbalance, and may affect the healing of the operative area and increase the risk of complications. Recent studies in rapid recovery surgery have demonstrated that an appropriate reduction in preoperative fasting and drinking time does not increase the risk of reflux-related aspiration. however, thirst, hunger, pain, nausea, vomiting, and anxiety are associated with a better surgical experience. encouraging physicians to explore more ways to reduce preoperative fasting and drinking time.(1). Reduced fasting times have been found to provide effective positive feedback in multiple multidisciplinary procedures(2–5). In this case study also, it was found that with oral nutritional support given 2 hours before surgery, the child's thirst, hunger, and anxiety were decreased evidently. Also traditionally prolonged fasting does not significantly increase the risk of surgical complications and anesthetic complications.
The side effects of prolonged preoperative fasting are more pronounced in pediatric patients than in adults. After preoperative fasting and fasting time superimposed on postoperative fasting, children are prone to hypoglycemia and electrolyte disturbances, which are mostly asymptomatic but should still be taken seriously(6, 7). Anesthesiologists and pediatricians are more aware of the benefits of shorter preoperative fasting times and have made more clinical observations(7, 8). Children are more vulnerable than adults, and prolonged fasting and surgical stress can lead to more anxiety and a poorer experience for the child.(9). A study by Carvalho found that prolonged fasting led to an increase in the preoperative CRP/albumin ratio, and it was hypothesized that getting some carbohydrate-rich beverages on an empty stomach before surgery would improve the metabolic and inflammatory response in preschool children with inguinal hernia surgery(10).
Appropriate preoperative fasting times and preoperative fluid volumes constantly exploring. According to US anesthesia guidelines, fluid replacement is recommended 90 minutes before entering the operating room(3). Taye's study found that gastric volume returned to baseline levels within 1 hour even after ingestion of 5 ml clear fluids per kilogram body weight, so even if the preoperative fasting time is reduced to 1 h, healthy children undergoing elective surgery can drink up to 5 ml clear fluids per kilogram body weight, which is still a safe range(11). Beck’s study concerned that The median ingested fluid volume was 4.7 (range 1.8–11.8) mL per kilogram body weight in 24 children, and gastric emptying within 52 min was achieved with no more than 5 ml fluid per kilogram body weight (12). However, the problem of the separation of theory and practice lies. Fasting time from drinking is difficult to control accurately, and most of the time there is a delay, mainly due to parental concerns, and surgical anesthesia departmental articulation(9, 13). In A J Kouvarellis' study, it was similarly found that there was a large discrepancy between clinical and guidelines and that systematic quality improvement was needed to make it possible to reduce the discrepancy(14).
The application of ERAS in children deserves more attention. There are limitations in this study, as there are not enough large, multi-hospital large-scale data, and detailed individual BMI and perioperative anxiety score factors are not included, which need more research and exploration. The appropriate time of fasting and drinking before the operation still needs to be further explored and optimized. Early postoperative food intake and nutritional supplementation are also important, especially in patients with eating disorders caused by pain and surgical site infection after pharyngeal surgery such as tonsil surgery. The prolonged gastric emptying time of some children cannot be explained, so it is not recommended to shorten the preoperative fasting time radically, and the safety of anesthesia should be prioritized. Further exploration is needed to evaluate the individualized duration of fasting before surgery, and the procedure of shortening the duration of fasting before surgery in clinical practice still needs to be optimized.