Fatores associados ao tempo de jejum de pacientes pediátricos internados para procedimento cirúrgico
Factors associated with fasting time in pediatric patients hospitalized for surgery
Laura Naspitz; Fernanda Luísa Ceragioli Oliveira; Renato Lopes de Souza; Tulio Konstantyner
Resumo
Objetivo: O menor tempo de jejum para cirurgias tem sido associado a melhor recuperação pós-operatória e menor morbimortalidade. No entanto, nem sempre é possível alcançar as recomendações atuais na prática pediátrica. Sendo assim, é essencial conhecer o tempo de jejum e seus fatores associados para elaboração de estratégias assistenciais.
Métodos: Coorte com 284 pacientes pediátricos admitidos para cirurgia entre 2020-2021, no Hospital São Paulo, Brasil. Dados foram obtidos por meio de entrevista e do prontuário médico. Para o estudo das associações foram ajustados modelos de regressão linear e logística simples e múltiplos.
Resultados: Todos pacientes apresentaram jejum pré-operatório prolongado e a maioria reiniciou a dieta após 6 horas do término anestésico. O tempo de jejum pré-operatório para cirurgias eletivas foi menor do que para as de urgências (p=0,025). Os fatores associados ao maior tempo de jejum pré-operatório (minutos) foram: maior idade em anos (β=10; IC95%=5,2-14,8) e ocorrência de cirurgia anterior (β=76,6; IC95%=28,0-125,1). Os fatores associados ao tempo de jejum pós-operatório superior a 6h foram: não realização do pós-operatório imediato na enfermaria cirúrgica (OR=6,05; IC95%=2,25-16,22), presença de complicações durante a cirurgia (OR=3,53; IC95%=1,19-10,47), porte cirúrgico maior (OR=3,85; IC95%=1,49-9,93), cirurgia do tipo abdominal (OR=36,52; IC95%=13,48-98,91) e presença de vômitos nas primeiras 24 horas de pós-operatório (OR=3,44; IC95%=1,54-7,69).
Conclusão: Há fatores potencialmente modificáveis que foram associados ao maior tempo de jejum. Treinamento e organização da equipe assistencial quanto às características dos pacientes, dinâmica do atendimento e intercorrências clínicas podem contribuir com maior adequação do tempo de jejum de pacientes pediátricos internados para procedimentos cirúrgico.
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Referências
1 Schlich T. The history of anaesthesia and the patient-reduced to a body? The Lancet. 2017;390(10099):1020-1. doi:10.1016/s0140-6736(17)32362-0.
2 Maltby JR. Fasting from midnight - the history behind the dogma. Best Pract Res Clin Anaesthesiol. 2006;20(3):363-78. doi: 10.1016/j.bpa.2006.02.001.
3 Mendelson CL. The Aspiration of Stomach Contents into the Lungs During Obstetric Anesthesia. Am J Obstet Gynecol.. 1946;52(2):191-205. doi: 10.1016/s0002-9378(16)39829-5.
4 Andersson H, Zarén B, Frykholm P. Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite. von Ungern-Sternberg B, editor. Paediatr Anaesth. 2015;25(8):770-7. doi: 10.1111/pan.12667.
5 Brady MC, Kinn S, Stuart P, Ness V. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003:(4):CD004423. doi: 10.1002/14651858.CD004423.
6 Aguilar-Nascimento JE, Caprossi C, Salomao AB, editores. ACERTO: acelerando a recuperação total pós-operatória. 2a ed. Rio de Janeiro: Editora Rubio; 2011.
7 Ljungqvist O. Insulin Resistance and Outcomes in Surgery. J Clin Endocrinol Metab. 2010 Sep;95(9):4217-9. doi: 10.1210/jc.2010-1525.
8 Conselho Federal de Medicina. Resolução CFM n. 2174/2017. Dispõe sobre a prática do ato anestésico e revoga a Resolução CFM nº 1.802/2006. Diário Oficial da União 2017 Dez 14; p. 82.
9 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 Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017;126(3):376-93. doi: 10.1097/aln.0000000000001452.
10 Dobson G, Chong M, Chow L, Flexman A, Kurrek M, Laflamme C, et al. Guidelines to the Practice of Anesthesia - Revised Edition 2018. Can J Anaesth. 2018;65(1):76-104. doi: 10.1007/s12630-017-0995-9.
11 Smith I, Kranke P, Murat I, Smith A, O'Sullivan G, Sreide E, et al. Perioperative fasting in adults and children. Eur J Anaesthesiol. 2011;28(8):556-69. doi: 10.1097/eja.0b013e3283495ba1.
12 Adenekan A. Perioperative blood glucose in a paediatric daycase facility: Effects of fasting and maintenance fluid. Afr J Paediatr Surg. 2014;11(4):317. doi: 10.4103/0189-6725.143140.
13 Brunet-Wood K, Simons M, Evasiuk A, Mazurak V, Dicken B, Ridley D, et al. Surgical fasting guidelines in children: Are we putting them into practice? J Pediatr Surg. 2016;51(8):1298-302. doi: 10.1016/j.jpedsurg.2016.04.006.
14 Ljungqvist O. ERAS - Enhanced recovery after surgery. J Visc Surg. 2011;148(3):e157-9. doi: 10.1016/j.jviscsurg.2011.05.016.
15 Assis MCS, Silveira CRM, Beghetto MG, Mello ED. Is duration of postoperative fasting associated with infection and prolonged length of stay in surgical patients? Nutr Hosp. 2014;30(4):919-26. doi: 10.3305/nh.2014.30.4.7528.
16 Sanfilippo F, Spoletini G. Perspectives on the importance of postoperative ileus. Curr Med Res Opin. 2015;31(4):675-6. doi: 10.1185/03007995.2015.1027184.
17 AMB [internet]. Classificação Brasileira Hierarquizada de Procedimentos Médicos 2012 [cited 2020 Jul 08]. Available from:
18 American Society of Anesthesiologists [internet]. ASA Physical Status Classification System 2014 [cited 2020 jul 08]. Available from:
19 Pesquisa ABEP [internet]. Novo Critério de Classificação Econômica Brasil 2018 [cited 2020 jul 08]. Available from:
20 Siegel S CN. Nonparametric Statistics for the Behavioral Sciences. 2nd ed. New York: McGraw-Hill International Editions; 1988. 399 p.
21 Favero LP. Análise de dados, técnicas multivariadas exploratórias. 2015:344.\
22 Leotti VB, Mancuso ACB, Borges RB, Castro SM de J, Hirakata VN, Camey SA. Modelagem estatística: Perguntas que você sempre quis fazer, mas nunca teve coragem. Clin Biomed Res. 2019;39:356-63. doi: 10.22491/2357-9730.98944.
23 El-Sharkawy AM, Daliya P, Lewis-Lloyd C, Adiamah A, Malcolm FL, Boyd-Carson H, et al. Fasting and surgery timing (FaST) audit. Clinical Nutrition. 2021;40(3):1405-12. doi: 10.1016/j.clnu.2020.08.033.
24 Falconer R, Skouras C, Carter T, Greenway L, Paisley AM. Preoperative fasting: current practice and areas for improvement. Updates Surg. 2014;66(1):31-9. doi: 10.1007/s13304-013-0242-z.
25 Williams C, Johnson PA, Guzzetta CE, Guzzetta PC, Cohen IT, Sill AM, et al. Pediatric Fasting Times Before Surgical and Radiologic Procedures: Benchmarking Institutional Practices Against National Standards. J Pediatr Nurs. 2014;29(3):258-67. doi: 10.1016/j.pedn.2013.11.011.
26 Andersson H, Schmitz A, Frykholm P. Preoperative fasting guidelines in pediatric anesthesia. Curr Opin Anaesthesiol. 2018;31(3):342-8. doi: 10.1097/aco.0000000000000582.
27 Francisco SC, Batista ST, Pena GG. Fasting in elective surgical patients: Comparison among the time prescribed, performed and recommended on perioperative care protocols. ABCD arq bras cir dig. 2015;28(4):250-4. doi: 10.1590/s0102-6720201500040008.
28 Pearse R, Rajakulendran Y. Pre-operative fasting and administration of regular medications in adult patients presenting for elective surgery. Has the new evidence changed practice? Eur J Anaesthesiol. 1999;16(8):565-8. doi: 10.1097/00003643-199908000-00013.
29 Cestonaro T, Madalozzo Schieferdecker ME, Thieme RD, Neto Cardoso J, Ligocki Campos AC. The reality of the surgical fasting time in the era of the ERAS protocol. Nutr Hosp. 2014;29(2):437-43. doi: 10.3305/nh.2014.29.2.7025.
30 Gebremedhn EG, Nagaratnam VB. Audit on preoperative fasting of elective surgical patients in an African academic medical center. World J Surg. 2014;38(9):2200-4. doi: 10.1007/s00268-014-2582-3.
31 Dolgun E, Yavuz M, Eroglu B, Islamoglu A. Investigation of Preoperative Fasting Times in Children. J Perianesth Nurs. 2017;32(2):121-4. doi: 10.1016/j.jopan.2014.12.005.
32 Al-Robeye AM, Barnard AN, Bew S. Thirsty work: Exploring children's experiences of preoperative fasting. Paediatr Anaesth. 2020;30(1):43-9. doi: 10.1111/pan.13759.
33 Kouvarellis AJ, Van der Spuy K, Biccard BM, Wilson G. A prospective study of paediatric preoperative fasting times at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. S Afr Med J. 2020;110(10):1026-31. doi: 10.7196/samj.2020.v110i10.14814.
34 Assen HE, Hassen AM, Abate A, Liyew B. Preoperative Fasting Time and Its Association with Hypoglycemia during Anesthesia in Pediatric Patients Undergoing Elective Procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Biomed Res Int. 2021;2021(1). doi: 10.1155/2021/9166603.
35 Yimer AH, Haddis L, Abrar M, Seid AM. Adherence to pre-operative fasting guidelines and associated factors among pediatric surgical patients in selected public referral hospitals, Addis Ababa, Ethiopia: Cross sectional study. Ann Med Surg (Lond). 2022;21:78:103813. doi: 10.1016/j.amsu.2022.103813.
36 van Noort HHJ, Eskes AM, Vermeulen H, Besselink MG, Moeling M, Ubbink DT, et al. Fasting habits over a 10-year period: An observational study on adherence to preoperative fasting and postoperative restoration of oral intake in 2 Dutch hospitals. Surgery. 2021;170(2):532-40. doi: 10.1016/j.surg.2021.01.037.
37 Abola RE, Gan TJ. Preoperative Fasting Guidelines: Why Are We Not Following Them?: The Time to Act Is NOW. Anesth Analg. 2017;124(4):1041-3. doi: 10.1213/ane.0000000000001964.
38 Shime N, Ono A, Chihara E, Tanaka Y. Current practice of preoperative fasting: a nationwide survey in Japanese anesthesia-teaching hospitals. J Anesth. 2005;19(3):187-92. doi: 10.1007/s00540-005-0319-z.
39 Tsang E, Lambert E, Carey S. Fasting leads to fasting: examining the relationships between perioperative fasting times and fasting for symptoms in patients undergoing elective abdominal surgery. Asia Pac J Clin Nutr. 2018;27(5):968-74. doi: 10.6133/apjcn.042018.04.
40 Sun ZJ, Sun X, Huo Y, Mi M, Peng GL, Zhang CL, et al. Abbreviated perioperative fasting management for elective fresh fracture surgery: guideline adherence analysis. BMC Musculoskelet Disord. 2022;23(1):688. doi: 10.1186/s12891-022-05574-5.
41 Carvalho CALB, Carvalho AA, Nogueira PLB, Aguilar-Nascimento JE. Changing paradigms in preoperative fasting: results of a joint effort in pediatric surgery. ABCD Arq Bras Cir Dig. 2017;30(1):7-10. doi: 10.1590/0102-6720201700010003.
42 de Aguilar-Nascimento JE, Bicudo-Salomão A, Caporossi C, Silva RM, Cardoso EA, Santos TP. Enhancing surgical recovery in Central-West Brazil: The ACERTO protocol results. e-SPEN. 2008;3(2):78-83. doi: 10.1016/j.eclnm.2008.01.003.
43 Newton RJG, Stuart GM, Willdridge DJ, Thomas M. Using quality improvement methods to reduce clear fluid fasting times in children on a preoperative ward. Paediatr Anaesth. 2017;27(8):793-800. doi: 10.1111/pan.13174.
44 Gandolfo AS, Cardoso PFN, Buscatti IM, Velhote MCP, Bonfim MAC, Helito AC. Implementation of a preoperative fasting abbreviation protocol in a tertiary pediatric center. Clinics. 2021;76:e2995. doi: 10.6061/clinics/2021/e2995.
45 Lai L, Zeng L, Yang Z, Zheng Y, Zhu Q. Current practice of postoperative fasting: results from a multicentre survey in China. BMJ Open. 2022;12(7):e060716. doi: 10.1136/bmjopen-2021-060716.
46 Schenk J, de Klerk ES, Bouman D, Geerts BF, Hollmann MW, Hermanides J, et al. Reducing postoperative fasting times by implementing a food service in the Post Anaesthesia Care Unit (PACU). Clin Nutr ESPEN. 2022;51:280-7. doi: 10.1016/j.clnesp.2022.08.015.
47 Mariette C. Role of the nutritional support in the ERAS programme. J Visc Surg. 2015;152 Suppl 1:S18-20. doi: 10.1016/s1878-7886(15)30006-0.
48 Franco AC, Bicudo-Salomão A, Aguilar-Nascimento JE, Santos TB, Sohn RV. Uso da realimentação pós-operatória ultra precoce e seu impacto na redução de fluidos endovenosos. Rev Col Bras Cir 47:e20202356. doi: 10.1590/0100-6991e-20202356.
49 Kyrtatos PG, Constandinou N, Loizides S, Mumtaz T. Improved patient education facilitates adherence to preoperative fasting guidelines. J Perioper Pract. 2014;24(10):228-31. doi: 10.1177/175045891402401003.
50 Khoyratty S, Modi BN, Ravichandran D. Preoperative starvation in elective general surgery. J Perioper Pract. 2010;20(3):100-2. doi: 10.1177/175045891002000302.
Submetido em:
27/01/2025
Aceito em:
07/09/2025
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