Fasting

A number of studies have found no difference in gastric residual volume or pH in children allowed to ingest unlimited clear liquids (water, apple juice) up until 2 to 3 hours before anesthetic induction as opposed to standard fasting. ^{[240] [241]} This practice provides a more humane approach for both children and their parents without increasing the risk of pulmonary aspiration of gastric contents.^[242] Infants and young children have a higher metabolic rate and a larger body surface area-weight ratio than adults do and become dehydrated more easily than adults. The major advantage of the liberalized fasting guidelines may be a reduced incidence of hypovolemia at the time of anesthetic induction. My approach is to restrict milk and solids after midnight but allow unlimited clear fluids up to 3 hours before induction; if a change in the operative schedule is necessary, I still feel comfortable with 2 hours of fasting ( Table 60-5 ). Infants who are breast-fed may have their last breast milk 4 hours before anesthetic induction. I consider breast milk to be equivalent to formula because the fat content varies with maternal diet and delayed gastric emptying may result.^[243]