Abstract
BACKGROUND: Paediatric patients undergoing procedures under general anaesthesia tend to follow a standardised fasting regimen, including a 2-h clear fluid fast, to reduce the risk of pulmonary aspiration and other perioperative complications. This can lead to prolonged real-world fasting times and associated adverse outcomes. However, the evidence regarding the risks and benefits of shortening the preoperative fasting time in children is unclear. METHODS: Randomised controlled trials comparing the effect of shorter and longer preoperative fasting times on clinical outcomes in children were identified by systematically searching the medical databases MEDLINE, Embase, Web of Science, CINAHL, and Cochrane CENTRAL (inception until August 22, 2024). Pooled standardised mean differences (SMDs; 95% confidence interval [CI]) were calculated where possible, after assessment of risk of bias with the Cochrane Collaborations risk of bias tool. RESULTS: Eight studies analysing 1234 patients were included. No significant difference was found in gastric residual volume (SMD, -0.05; 95% CI, -0.17 to 0.07) or gastric pH (SMD, -0.11; 95% CI, -0.31 to 0.09) between shorter and longer fasting groups. Shorter fasting groups experienced equivalent or reduced postoperative nausea and vomiting, thirst, and hunger. CONCLUSIONS: This systematic review and meta-analysis did not find an increased risk of pulmonary aspiration associated with preoperative clear fluid fasting of ≤1 h in children. Our findings have promising clinical implications and support the safety and practicality of liberal fasting regimens in paediatric patients undergoing anaesthesia. Further rigorous RCTs and national audits will strengthen the evidence base on this subject. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42024577954).