• Eileen Zhang, Neil Hauser, Aine Sommerfield, David Sommerfield, and Britta S von Ungern-Sternberg.
• Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.
• Paediatr Anaesth. 2023 Dec 1; 33 (12): 101210191012-1019.

AbstractFasting for surgery is a routine step in the preoperative preparation for surgery. There have however been increasing concerns with regard to the high incidence of prolonged fasting in children, and the subsequent psycho-social distress and physiological consequences that this poses. Additionally, the past few years have yielded new research that has shown significant inter-individual variation in gastric emptying regardless of the length of the fast, with some patients still having residual gastric contents even after prolonged fasts. Additionally, multiple large-scale studies have shown no long-term sequalae from clear fluid aspiration, although two deaths from aspiration have been reported within the large Wake Up Safe cohort. This has led to a change in the recommended clear fluid fasting times in multiple international pediatric societies; similarly, many societies continue to recommend traditional fasting times. Multiple fasting strategies exist in the literature, though these have mostly been studied and implemented in the adult population. This review hopes to summarize the recent updates in fasting guidelines, discuss the issues surrounding prolonged fasting, and explore potential tolerance strategies for children.© 2023 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.

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