Does anyone know of any research like this? Her daughter just had a
procedure done in December at Johns Hopkins and was allowed to nurse 2-4 hours before.
So this seems to be very recent. She is trying to contact the
anesthesiologist for further information. Her daughter has major feeding problems, severe
reflux and allergies and nurses very
frequently (like every hour!) so 8 hours would be extremely difficult for her!
I did a search on Pub-Med with the keywords anesthesia and breast milk and
found some citations, Sarah. Click on related links for this first one and you
will get more studies. One is this:
Anaesthesia. 1999 Jan; 54(1): 51-9.
Comment in: Anaesthesia. 2000 May;55(5):501-2.
Safe pre-operative fasting times after milk or clear fluid in children. A
preliminary study using real-time ultrasound.
Sethi AK, Chatterji C, Bhargava SK, Narang P, Tyagi A.
Department of Anaesthesiology, University College of Medical Sciences & GTB
Hospital, Delhi, India.
Gastric emptying of orange-flavoured glucose (group I), low-fat milk (group
II) and breast milk (group III) was evaluated in 45 ASA grade I children of <
or = 5 years of age by using real-time ultrasonography and residual gastric
volume and pH was then measured. In 15 more children, residual gastric volume and
pH was measured after a midnight fast (group IV). Mean (SD) gastric emptying
time in group I was 1.53 (0.25) h (range 1.00-1.75), group II 2.32 (0.31) h
(range 1.75-2.75) and group III 2.43 (0.27) h (range 2.00-2.75). According to
Robert and Shirley's criteria, no children of group I and II were found to be
'at risk' at 2 h and 3 h, respectively, but 13.3% of group III children were
labelled as 'at risk' at 3 h. The incidence of 'at risk' children in group IV was
33.3%. It was concluded that 3% fat milk or 17.5% glucose in a volume of 10
ml.kg-1 (maximum volume of 100 ml) can be given in children safely 3 h and 2 h,
respectively, before anaesthesia. More real-time studies are required on
breast milk to establish guidelines for its potential use as a pre-operative feed
3 h before anaesthesia.
~~~~~~~~~~
1: Paediatr Anaesth. 2001 Mar; 11(2): 147-50.
Aspiration and regurgitation prophylaxis in paediatric anaesthesia.
Engelhardt T, Strachan L, Johnston G.
Department of Anaesthesia and Intensive Care, Grampian University Hospital
Trusts, Foresterhill, Aberdeen AB25 9ZD, UK.
BACKGROUND: Surveys of aspiration prophylaxis in paediatric anaesthesia do
not exist. METHODS: A postal survey was sent out to all UK members of the
Association of Paediatric Anaesthetists (APA) to assess current practice. We asked
about minimum fasting times for liquids and solids/milk, their routine acid
aspiration prophylaxis and perceived risk factors for emergency and elective
surgery in children those less than 1 year old and those aged 1-14 years. We also
asked if the APA member had more than 10 years experience in paediatric
anaesthesia. RESULTS: One hundred and two (55.1%) APA members replied out of a total
of 185 questionnaires sent. Eighty-eight (88/102) were considered valid.
Fasting in emergencies is approximately 4 h for solids/milk and 2 h for clear
liquids. Fasting for elective surgery is between 5 and 6 h for solids/milk and 2 h
for clear liquids. Pharmacological methods to reduce the risk of aspiration
are not used. Mechanical methods vary from 40-50% for cricoid pressure and
20-30% for nasogastric aspiration if a tube is present. The presence of a hiatus
hernia is perceived by over 80% as a risk factor, previous aspiration by over
60%, difficult intubation, cerebral palsy and sepsis by 20-30%. CONCLUSION:
Perceived risk factors vary with "experience": hiatus hernia, difficult
intubation and cerebral palsy are less important whereas previous aspiration and renal
failure appear to be more important for paediatric anaesthetists with less
than 10 years in paediatric anaesthetic practice.
This may be one that resulted in caution. But many of these are 1999 studies.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids
=10201666&dopt=Abstract states that there is a wide variety in fasting times.
This one published in 2003 is for formula feeds and has the 8 hour time for
formula:
Anesth Analg. 2003 Apr; 96(4): 965-9
A liberalized fasting guideline for formula-fed infants does not increase
average gastric fluid volume before elective surgery.
Cook-Sather SD, Harris KA, Chiavacci R, Gallagher PR, Schreiner MS.
Department of Anesthesiology and Critical Care Medicine, Division of
Biostatistics and Epidemiology, Children's Hospital of Philadelphia, 34th Street &
Civic Center Boulevard, Philadelphia, PA 19104, USA. [log in to unmask]
Recommended preoperative fasting intervals for infant formula vary from 4 to
8 h. We conducted a prospective, randomized, observer-blinded trial of 97 ASA
physical status I and II infants scheduled for elective surgery to determine
whether average gastric fluid volume (GFV) recovered from infants
formula-fasted for 4 h (liberalized fast, Group L) differed from that recovered from
infants allowed clear liquids up until 2 h, but fasted 8 h for formula and solids
(traditional fast, Group T). In Group L, 31 of 39 subjects followed protocol and
ingested formula 4-6 h before surgery. In Group T, 36 of 58 subjects followed
protocol, taking clear liquids 2-5 h before the induction of anesthesia.
Thirty subjects had prolonged fasts and were included only in a secondary
intent-to-treat analysis. Respective mean age (5.7 +/- 2.3 versus 6.4 +/- 2.4 mo;
range, 0.7-10.5 mo), weight (7.5 +/- 1.8 versus 7.5 +/- 1.1 kg), and volume of
last feed (4.9 +/- 2.2 versus 4.0 +/- 2.3 oz.) did not vary between Groups L and
T. GFV (L: 0.19 +/- 0.38 versus T: 0.16 +/- 0.30 mL/kg) and gastric fluid pH
(L: 2.5 +/- 0.5 versus T: 2.9 +/- 1.3) did not vary. For all subjects, GFV
(mL/kg) increased with age (Spearman correlation coefficient = +0.23, P = 0.03).
Infant irritability and hunger and parent satisfaction were similar between
groups. We conclude that average GFV after either a 4- to 6-h fast for infant
formula or 2-h fast after clear liquids is small and not significantly different
between groups. On the basis of these findings, clinicians may consider
liberalizing formula feedings to 4 h before surgery in selected infants.
IMPLICATIONS: Healthy infants aged
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