preoperative fasting durations, associated factors, and immediate preoperative outcomes among children undergoing elective surgery at mulago hospital.

Description

Background: Preoperative fasting is one of the cornerstones of perioperative patient safety. It is employed in the prevention of the fatal risk of pulmonary aspiration. This study sought to determine the preoperative fasting durations, associated factors and immediate preoperative outcomes among children undergoing elective surgery at Mulago Hospital. This would help in the adoption of preoperative fasting guidelines and the development of local protocols. Methods: In this cross-sectional study, 307 children and 217 healthcare providers were recruited. Data were collected by the use of a data collection tool, entered with Epi-data version 3.1 and was transferred to STATA 12 for analysis. Results: The children had a median age of 5(3-7) years with male predominance 169 (55%), undergoing a scheduled general anaesthetic 307 (100%) and 296 (96.4%) belonging to ASA I physical status. Malnutrition by MUAC cut-off in the 6–60 months old age group was found in 5 (4.2%) children while as by BMI for the whole cohort, it was noted in 10 (3.3%) children. Stunted and underweight children under five years were 20 (16%) and 10 (8%) respectively. We still found that 226 (73.6%) of the children had a protracted preoperative fast. None of the children had a short preoperative fast. Prolonged preoperative fasting duration correlated with getting unclear instructions AOR 4.35 (95% CI 1.00 – 18.85, P = 0.049). However, children were less likely to have a prolonged fast when instructions were given by the doctor AOR 0.11 (95% CI 0.05 - 0.23, P =<0.001) and the parent/guardian having a tertiary education AOR 0.34 (95% CI 0.16 - 0.74, P = 0.006). Hypoglycaemia was found in 75(24.43%) of the children and was associated with prolonged preoperative fasting durations AOR 3.92 (95% CI 1.42 - 10.79, P = 0.008). Likewise, we found that 92(29.97%) of the children had some/severe dehydration which was associated with prolonged preoperative fasting durations AOR 2.38 (95% CI 1,13-5.01, P = 0.023). Regarding knowledge of the APAGBI preoperative fasting guidelines, 171(78.8%) of the healthcare providers had pertinent knowledge. Conclusion: For the most part, the fasting times were twice as long as recommended by the APAGBI. There was a correlation between a prolonged fast and some factors. These were getting unclear orders, poor knowledge of the APAGBI guidelines, dehydration and hypoglycaemia. For further research, we should determine the long-term effects of fasting times in children.