Preoperative Fasting Guidelines and Their Importance for Children’s Health

Document Type : Letter to the Editor


Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran


Children, similar to adults, are required to fast before general anesthesia in order to reduce  the volume and acidity of stomach contents. It is thought that NPO regulations reduce the risk of regurgitation and aspiration of gastric contents during surgery. Recent developments have encouraged a shift from the standard 'nil by mouth from midnight' fasting policy to more relaxed regimens. Preoperative NPO status for each patient must be regulated according to his/her age and timing of the surgery, the night before the operation (2 hours for clear fluids and 4-6 hours for solid foods and milk before the surgery, considering his/her age).


  1. Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database of Systematic Reviews 2003;(4):CD004423
  2. Hamid SK, Selby IR, Sikich N, Lerman J. Vomiting after adenoton­sillectomy in children: a comparison of ondansetron, dimenhy­drinate, and placebo. Anesth Analg. 1998;86(3):496–500.

  3. Hamid S. Pre-operative fasting - a patient centered approach. BMJ Qual Improv Report 2014;2: doi:10.1136/bmjquality.u605.w1252
  4. Perioperative fasting in adults and children – a RCN guideline for the multidisciplinary team. Clinical practice guidelines, RCN publications, 2005. Available from:
  5. Kinn S , Ness V , O'Rourke K, Randhawa N, Stuart P.Preoperative fasting for preventing perioperative complications in children. Cochrane Database of Systematic Reviews,October 2009
  6. Smith AF, Vallance H, Slater RM. Shorter preoperative fluid fasts reduce postoperative emesis. BMJ. 1997;314(7092):1486.
  7. Emerson BM, Wrigley SR, Newton M. Pre-operative fasting for paediatric anaesthesia. A survey of current practice. Anaesthesia. 1998;53(4):326–30.

  8. Ewah BN, Robb PJ, Raw M. Postoperative pain, nausea and vom­iting following paediatric day-case tonsillectomy. Anaesthesia. 2006;61(2):116–22.

  9. Jabbari Moghaddam  Y, Seyedhejazi M, NaderPour  M, Yaghooblua Y, Golzari S.  Is Fasting Duration Important in Post Adenotonsillectomy Feeding Time?. Anesth Pain Med. 2014;3(3):e10256

  10. Nygren J, Thorell A, Ljungqvist O. Are there any benefits from minimizing fasting and optimization of nutrition and fluid management for patients undergoing day surgery? Curr Opin Anaesth. 2007;20(6):540–4.

  11. Seyedhejazi M, Jabbari Moghaddam Y, Rezazade Jodi M, Rahimi Panahi J, Bilajani E, Ghojazade M, et al. Comparison of intrave­nous fentanyl and infiltration of bupivacaine and clonidine in decreasing post tonsillectomy pain and complications in chil­dren. J Pharm Sci. 2012;18(2):141–9.

  12. Klemetti S, Kinnunen I, Suominen T, Antila H, Vahlberg T, Gren­man R, et al. The effect of preoperative fasting on postoperative pain, nausea and vomiting in pediatric ambulatory tonsillec­tomy. Int J Pediatr Otorhi. 2009;73(2):263–73.

  13. American Society of Anaesthesiologist task force on preoperative fasting. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anaesthesiologists Committee on standards and practice parameters. Anaesthesiology 2011;114(3)495-511.
  14. Maltby JR. Preoperative fasting guidelines. Canadian Journal of Anaesthesia 2006;49(2):138-9.
  15. Maltby JR, Lewis P, Martin A, Sutherland LR. Gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery. Canadian Journal of Anaesthesia 1991;38(4 Pt 1):425-9.
  16. Gebremedhn EG, Nagaratnam VB. World J Surg (2014) 38:2200–2204