Dear Editors,
We have just read the article 'Operative fasting guidelines and postoperative feeding in paediatric anaesthesia - current concepts'[1] and we really appreciate the liberal approach of 1-hour fasting period for clear fluids. However, we noticed that the authors did not discuss the situation of obese children in the section of special situations, which is actually a real big concern in our daily practice. My colleague and I have both encountered a situation of vomiting of gastric contents immediately after induction of anaesthesia in obese children undergoing urogenital surgery. These children did not develop aspiration because of doing suction in time and proper positioning. Quitadamo et al. reported a high percentage of obese children and adolescents experiencing gastro-oesophageal reflux disease symptoms,[2] which raised the concern of prolonging the fasting time for obese paediatric patients. We all know that both India and China have the highest number of obese children, so it would be very useful if the authors could supplement information of fasting time for this special group of children.[3]
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REFERENCES
- 1.Toms AS, Rai E. Operative fasting guidelines and postoperative feeding in paediatric anaesthesia-current concepts. Indian J Anaesth. 2019;63:707–12. doi: 10.4103/ija.IJA_484_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Quitadamo P, Zenzeri L, Mozzillo E, Cuccurullo I, Rocco A, Franzese A, et al. Gastric emptying time, esophageal pH-impedance parameters, quality of life, and gastrointestinal comorbidity in obese children and adolescents. J Pediatr. 2018;194:94–9. doi: 10.1016/j.jpeds.2017.10.039. [DOI] [PubMed] [Google Scholar]
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