Determining a Safe Time for Oral Intake Following Pediatric Sedation

Abstract

Objective: While there are suggestions for oral hydration times after general anesthesia, there is no published study with regard to sedation. The aim of this prospective study was to determine a safe time for oral intake after pediatric sedation and its association with nausea and vomiting after discharge.
Methods: A total of 180 children (aged 1 month to 13 years) sedated for magnetic resonance imaging were randomly assigned into three groups. All patients fasted for 6 hours and were allowed to take clear fluids until 2 hours before sedation with thiopental (3 mg/kg). After the patients were transported to the recovery room, we allowed the patients to drink as much clear fluids as they wanted prior to discharge in group I, 1 hour after the patients met the discharge criteria for group II, and 2 hours after the patients met the discharge criteria for group III. All patients were assessed for vomiting in the recovery room until 1 hour after their first oral hydration. The parents were then telephoned the next day and questioned regarding nausea/vomiting and any unanticipated hospital admission.
Results: There were no statistically significant intergroup differences with respect to age, sex, weight, or the ASA status. There was no nausea and vomiting in either the recovery or post discharge period in any group. In the telephone questionnaire, no hospital admissions were reported.
Conclusion: Oral hydration just before discharge is safe, and fasting children after discharge for a period of time is unnecessary for patients sedated with thiopental.
Key words: Sedation, oral intake, postoperative nausea and vomiting

Keywords

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Pediatrik Sedasyon Sonrası Oral Alım için Güvenli Zamanın Belirlenmesi

Abstract

Amaç: Genel anestezi sonrası oral sıvı alımı zamanı ile ilgili öneriler bulunmakla birlikte, sedasyon ile ilgili yayınlanan herhangi bir çalışma yoktur. Bu prospektif çalışmanın amacı pediatrik sedasyon sonrası oral ilk alım için güvenli zamanını belirlemek, bunun taburculuk sonrası bulantı kusma ile ilişkisini saptamaktır.Yöntemler: Manyetik rezonans görüntüleme için sedasyon uygulanan 180 çocuk (1 ay -13 yaş) rastgele üç gruba ayrıldı. Tüm hastalar tiyopental (3 mg/ kg) ile sedasyon öncesi 6 saat aç bırakıldı; 2 saat öncesine kadar berrak sıvı almalarına izin verildi. Derlenme odasına transfer sonrası grup I’ deki hastaların taburcu edilmeden hemen önce, grup II’ deki hastaların taburcu edilme kriterlerini karşıladıktan 2 saat sonra, grup III’ deki hastaların ise taburcu edilme kriterini karşılaştırdıktan 3 saat sonra diledikleri kadar oral berrak sıvı almalarına izin verildi. Tüm hastalar oral sıvı aldıkları zamandan 1 saat sonrasına kadar derlenme odasında kusma açısından takip edildi. Hastaların aileleri ertesi gün telefonla aranarak bulantı/kusma, umulmadık hastane başvurusu açısından sorgulandı.Bulgular: Gruplar arasında yaş, cinsiyet, vücut ağırlığı ya da ASA fiziksel durum sınıflaması açısından istatistiksel olarak anlamlı bir fark saptanmadı. Grupların hiçbirinde derlenme odası ve taburculuk sonrası bulantı ve kusma, telefon sorgulamasında umulmadık hastane başvurusu yoktu.Sonuç: Tiyopental ile sedatize edilen hastaların taburculuktan hemen önce oral sıvı alımı güvenli olup taburcu edildikten sonra aç kalmalarına gerek yoktur

Keywords

• Sedasyon, oral alım, postoperatif bulantı ve kusma

References

1. Metzner J, Domino KB. Risks of anesthesia or sedation outside
2. the operating room: the role of the anesthesia care provider. Curr Opin Anaesthesiol 2010;23:523-531.
3. Chang B, Kaye AD, Diaz JH, et al. Complications of Non-Operating Room Procedures: Outcomes From the National Anesthesia Clinical Outcomes Registry. J Patient Saf 2015. Published Ahead-of-Print.
4. Costa LR, Costa PS, Brasileiro SV, et al. Post-discharge adverse
5. events following pediatric sedation with high doses of oral medication. J Pediatr 2012;160:807-813.
6. Apfelbaum JL, Silverstein JH, Chung FF, et al. Practice guidelines
7. for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology 2013;118:291-307.
8. Yin X, Ye L, Zhao L, et al. Early versus delayed postoperative oral hydration after general anesthesia: a prospective randomized trial. Int J Clin Exp Med 2014;7:3491-3496.

9. Cheng W, Chow B, Tam PK. Electrogastrographic changes in children who undergo day-surgery anesthesia. J Pediatr Surg 1999;34:1336-1338.
10. Malviya S, Voepel-Lewis T, Prochaska G, Tait AR. Prolonged
11. recovery and delayed side effects of sedation for diagnostic imaging studies in children. Pediatrics 2000;105:E42.
12. Mercan A, El-Kerdawy H, Bhavsaar B, Bakhamees HS. The effect of timing and temperature of oral fluids ingested after minor surgery in preschool children on vomiting: a prospective, randomized, clinical study. Paediatr Anaesth 2011;21:1066-1070.
13. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth 1995;7:89-91.
14. Missant C, Van de Velde M. Morbidity and mortality related to anaesthesia outside the operating room. Curr Opin Anaesthesiol
15. ;17:323-327.
16. Carroll NV, Miederhoff P, Cox FM, Hirsch JD. Postoperative nausea and vomiting after discharge from outpatient surgery centers. Anesth Analg 1995;80:903-909.
17. Radke OC, Biedler A, Kolodzie K, et al. The effect of postoperative
18. fasting on vomiting in children and their assessment of pain. Paediatr Anaesth 2009;19:494-499.
19. Guo J, Long S, Li H, et al. Early versus delayed oral feeding for patients after cesarean. Int J Gynaecol Obstet 2015;128:100-105.
20. Karamnov S, Sarkisian N, Grammer R, et al. Analysis of Adverse Events Associated With Adult Moderate Procedural Sedation Outside the Operating Room. J Patient Saf 2014.Published Ahead-of-Print
21. Kouchaji C. Complications of IV sedation for dental treatment
22. in individuals with intellectual disability. Eg J Anaesth 2015;31:143-148.
23. Masters LT, Perrine K, Devinsky O, Nelson PK. Wada testing in pediatric patients by use of propofol anesthesia. AJNR Am J Neuroradiol 2000;21:1302-1305.
24. Krauss B, Green SM. Procedural sedation and analgesia in children. Lancet 2006;367:766-780.
25. Nguyen NQ, Chapman MJ, Fraser RJ, et al. The effects of sedation on gastric emptying and intra-gastric meal distribution in critical illness. Intensive Care Med 2008;34:454-460.
26. Chassard D, Lansiaux S, Duflo F, et al. Effects of subhypnotic
27. doses of propofol on gastric emptying in volunteers. Anesthesiology 2002;97:96-101.
28. Yuan CS, Foss JF, O’Connor M, et al. Effects of low-dose morphine on gastric emptying in healthy volunteers. J Clin Pharmacol 1998;38:1017-1020.
29. Crighton IM, Martin PH, Hobbs GJ, et al. A comparison of the effects of intravenous tramadol, codeine, and morphine on gastric emptying in human volunteers. Anesth Analg 1998;87:445-449.