Impact of an unrestricted clear liquid fasting protocol on pediatric perioperative outcomes: a prospective interventional study

PURPOSE: Traditional preoperative fasting guidance (6-4-2) aims to reduce aspiration risk but frequently produces prolonged fasting and discomfort in children. We evaluated whether progressively liberalizing the clear-liquid fasting policy reduces fasting time and improves the perioperative experience. METHODS: We conducted a prospective, four-phase interventional quality-improvement study at a tertiary hospital in rural Kenya (11/2021-12/2022). Phase 0 followed standard 6-4-2 guidelines; Phase 1 shortened clear-liquid fasting to 1 h; Phase 2 permitted a fixed volume of water until transfer to theatre; Phase 3, unrestricted water. The primary outcome was clear-liquid fasting time. Secondary outcomes were thirst, hunger, parental satisfaction, preoperative anxiety, and aspiration events. RESULTS: Among 253 children, median clear-liquid fasting time decreased: 14.0 h (Phase 0) to 1.7 h (Phase 3) (p < 0.001). Anxiety decreased significantly (mYPAS 35.4 to 22.9; p < 0.001) and thirst declined. Parental satisfaction was higher but did not reach statistical significance (8.0 to 9.0; p = 0.06). One confirmed aspiration occurred in Phase 1 (7.2-h fasting time). CONCLUSION: Reducing preoperative fasting improved comfort and lowered anxiety. No increase in clinically significant aspiration events was observed, although the study was not powered for rare events. An unrestricted clear-liquid protocol appears feasible and beneficial.