• Vidura Jayasinghe, Pk Buddhika Mahesh, Cmd Sooriaarachchi, Jimutha Jayalath, Weranga Karunarathne, and S N Liyanage.
• Department of Community Medicine, Post-Graduate Institution of Medicine, University of Colombo, Colombo, Sri Lanka.
• Indian J Anaesth. 2018 May 1; 62 (5): 366-370.

Background And AimsNon-adherence to standard fasting guidelines may result in perioperative complications. We aimed to determine the association between pre-operative over-fasting and post-operative vomiting amongst children undergoing bone marrow aspiration under general anaesthesia.MethodsA prospective cohort study was conducted from May 2015 to April 2016 in children undergoing bone marrow aspiration under general anaesthesia and their caregivers. Children fasted for ≥3 hours from last clear fluid intake constituted the exposed group (n = 202) while children fasting for <3 h constituted the non-exposed group (n = 202). The primary outcome was the development of post-operative vomiting during the 6 h following induction of anaesthesia. The awareness of the caregiver regarding the importance of keeping the child fasting before anaesthesia was evaluated.ResultsThe mean (standard deviation) duration time of fasting of the exposed and non-exposed groups were 7.2 (2.4) and 2.2 (0.3) h, respectively. Thirty-two (15.8%) children in the exposed group and 17 (8.4%) children in the non-exposed group developed post-operative vomiting. The relative risk of developing post-operative vomiting amongst over-fasting children was 1.9 (95% confidence interval [CI] = 1.1-3.3, P = 0.02), while adjusting to the age, it was 2.1 (95% CI = 1.1-4). Significantly more caregivers were clear about the fasting advice in the non-exposed group than in the exposed group (P < 0.001).ConclusionOver-fasting is a significant risk factor to develop post-operative vomiting in paediatric anaesthetic practice.

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