{"id":7195,"date":"2023-05-25T13:33:14","date_gmt":"2023-05-25T11:33:14","guid":{"rendered":"https:\/\/www.euroespa.com\/?page_id=7195"},"modified":"2023-05-25T13:33:17","modified_gmt":"2023-05-25T11:33:17","slug":"guidelines-archive","status":"publish","type":"page","link":"https:\/\/www.euroespa.com\/science-education\/specialized-sections\/espa-guidelines\/guidelines-archive\/","title":{"rendered":"Guidelines Archive"},"content":{"rendered":"\r\n
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Emergency care<\/span><\/h3>\r\n
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Management of a Patient with Suspected Anaphylaxis During Anaesthesia<\/p>\n

This two page Safety Drill includes the immediate and secondary management of adults and children who develop anaphylaxis.\u00a0 Drug dosages are included.\u00a0 The Safety Drill is easy to laminate and have available wherever children are anaesthetised.
\nThe ESPA Action Card for this emergency is also included.<\/p>\n

Link to the guideline: TBA<\/p>\n

See below an example of the ESPA Action Card for the management of Anaphylaxis:<\/p>\n

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Fasting guidelines<\/span><\/h3>\r\n
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Summary<\/h2>\n
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Pediatric anesthetic guidelines for the management of preoperative fasting of clear fluids are currently 2\u00a0hours. The traditional 2\u00a0hours clear fluid fasting time was recommended to decrease the risk of pulmonary aspiration and is not in keeping with current literature. It appears that a liberalized clear fluid fasting regime does not affect the incidence of pulmonary aspiration and in those who do aspirate, the sequelae are not usually severe or long\u2010lasting. With a 2\u2010hour clear fasting policy, the literature suggests that this translates into 6\u20107\u00a0hours actual duration of fasting with several studies up to 15\u00a0hours. Fasting for prolonged periods increases thirst and irritability and results in detrimental physiological and metabolic effects. With a 1\u2010hour clear fluid policy, there is no increased risk of pulmonary aspiration and studies demonstrate the stomach is empty. There is less nausea and vomiting, thirst, hunger, and anxiety, if allowed a drink closer to surgery. Children appear more comfortable, better behaved and possibly more compliant. In children less than 36\u00a0months this has positive physiological and metabolic effects. It is practical to allow children to drink until 1 hour prior to anesthesia on the day of surgery. In this joint consensus statement, the Association of Paediatric Anaesthetists of Great Britain and Ireland, the European Society for Paediatric Anaesthesiology, and L’Association Des Anesth\u00e9sistes\u2010R\u00e9animateurs P\u00e9diatriques d’Expression Fran\u00e7aise agree that, based on the current convincing evidence base, unless there is a clear contraindication, it is safe and recommended for all children able to take clear fluids, to be allowed and encouraged to have them up to 1\u00a0hour before elective general anesthesia.<\/p>\n<\/div>\n<\/section>\n<\/div>\n

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1 BACKGROUND<\/h2>\n

Pediatric anesthetic guidelines for the management of preoperative fasting of clear fluids are currently 2\u00a0hours.1<\/a><\/span>\u00a0The traditional 2\u2010hour clear fluid fasting time was recommended to decrease the risk of pulmonary aspiration and is not in keeping with current literature. It is based on historical adult literature2<\/a>,\u00a03<\/a><\/span>\u00a0that may not be applicable to the pediatric population. Mendelson’s landmark paper showed a mortality effect in the obstetric population if they aspirated solid material, but there were no long\u2010term sequelae in those who aspirated clear fluid.<\/p>\n

Pulmonary aspiration is a rare event in children, with an incidence of 0.07%\u20100.1%.3<\/a>–8<\/a><\/span>\u00a0The recent APRICOT9<\/a><\/span>\u00a0study found an incidence of 9.3\/10\u00a0000\u00a0=\u00a000.093%. The latter of course, included emergency and unfasted patients as well as elective children.<\/p>\n

It appears that a liberalized clear fluid fasting regime does not affect the incidence of pulmonary aspiration,10<\/a>,\u00a011<\/a><\/span>\u00a0and in those who do aspirate, the sequelae are not usually severe or long\u2010lasting.4<\/a>,\u00a07<\/a><\/span>\u00a0Aspiration was cited as being responsible for 2% of cardiac arrests in the POCA II registry which of course included emergency and unfasted patients.12<\/a><\/span><\/p>\n

With a 2\u2010hour clear fluids fasting policy, the literature suggests that this translates into 6\u20107\u00a0hours actual duration of fasting10<\/a>–17<\/a><\/span>\u00a0with several studies up to 15\u00a0hours.18<\/a>,\u00a019<\/a><\/span>\u00a0Fasting for prolonged periods increases thirst and irritability20<\/a><\/span>\u00a0and results in detrimental physiological and metabolic effects.13<\/a>,\u00a021<\/a><\/span><\/p>\n

The aim of developing these guidelines was to provide current evidence on perioperative fasting of clear fluids for elective surgery, minimize side effects of fasting while balancing against the risk of aspiration of gastric contents in the perioperative period and to provide a consensus statement on clear fluids fasting guidelines (Figure\u00a01<\/a>).<\/p>\n

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Figure 1<\/p>\n<\/div>\n<\/figcaption>\"\"

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Signatures supporting consensus statement<\/div>\n<\/figcaption><\/figure>\n<\/section>\n

For these guidelines, the clear fluids are defined as water, clear (nonopaque) fruit juice or squash\/cordial, ready diluted drinks, and nonfizzy sports drinks. Non\u2010thickened, non\u2010carbonated. The recommended maximum volume of clear fluids is 3\u00a0mL\/kg.<\/p>\n<\/section>\n

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2 RECOMMENDATIONS FOR GOOD CLINICAL PRACTICE<\/h2>\n