Perioperative fasting times in children and adolescents

The German Scientific Working Group for Paediatric Anaesthesia (Wissenschaftlicher Arbeitskreis Kinderansthesie, WAKKA) of the German Society for Anaesthesia and Intensive Care Medicine (DGAI) has updated their current recommendations on preoperative fasting in children from 2007, along with the preoperative fasting statement of the German Association of Anaesthesiologists (Berufsverband Deutscher Anasthesisten, BDA) and DGAI from 2016 in agreement with the new evidence-based European Guideline of the European Society of Anaesthesiology and Intensive Care (ESAIC) of 2022 - and transferred it into the S1 Guideline format of the Association of the Scientific. Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgeselischaften e. V., AWMF). This revision became necessary because recent studies had shown that optimized fasting times improved hornoeostasis and well-being of the children, while the risk of regurgitation and aspiration had not increased. On the other hand, long periods of fasting might be the cause of misbehaviour, stress, iatrogenic dehydration and catabolism. The updated S1 Guideline therefore recommends shorter fasting times of 4 hours for small, light meals and/or formula or cow's milk (still 6 hours for a full meal), 3 hours for breast milk, and 1 hour for clear fluids (6-4-3-1 Rule). In addition, the new S1 Guideline contains further recommendations for children with concomitant diseases that are of relevance to anaesthesia, for the application of ultrasound to examine the stomach content prior to the induction of anaesthesia, for postoperative fasting and the implementation of the new rules in clinical practice.