Patient Characteristics Associated with NPO (Nil Per Os) Non-Compliance in the Pediatric Surgical Population.

Introduction: Cancellation of surgery or delay on the day of service is a huge burden for the patient, family, and healthcare system. Preventable delays impact efficiency and workflow, which may increase costs due to overtime and idle rooms during peak hours. Non-compliance to nil per os (NPO) guidelines remains one of the most common preventable causes for surgical cancellations. The current study sought to investigate and understand patient factors that may be associated with non-compliance to NPO guidelines. Methods: After IRB approval, a retrospective review of completed and cancelled pediatric procedures requiring the use of anesthesia over a 5-year period was performed. Emergency procedures and inpatient surgeries were excluded. Data regarding patient demographics and surgical service were extracted from the electronic medical records for comparison. A logistic regression model was used to identify factors associated with cancellations due to NPO non-compliance. Results: There were 825 cancellations due to NPO non-compliance of 144,049 cases for an incidence of 0.57% over the 5-year period. Patients in the 6-12 year old age range and those who self-identified as non-White or non-English speaking had a higher incidence of cancelling due to NPO non-compliance. Compared to ear, nose, and throat (ENT) procedures, cancellations due to NPO non-compliance were more likely in radiology, dental, and urology procedures. Discussion: Many factors may impact a family's compliance with NPO guidelines. Patient-related factors included those who self-identified as non-White or non-English speaking. Patients having ENT surgery were less likely to have NPO non-compliance than those having radiologic procedures, dental surgery, or urologic surgery. Future interventions focused on these groups may be most effective in limiting day of surgery cancellations.

Point-of-Care Gastric Ultrasound in a Pediatric Patient After Bowel Preparation: A Case Report.

Polyethylene glycol electrolyte solutions (PEG, NuLYTELY®) are widely used to prepare the GI tract before colonoscopy or barium enema examinations. Although PEG appears as a clear liquid, the optimal interval for sedation or general anesthesia after the last administration of these solutions is unclear and controversial in the anesthetic literature. We present a 3-year-old patient with intermittent bloody stools who required anesthetic care for esophagogastroduodenoscopy (EGD) and colonoscopy. Given the controversial nil per os time with the use of PEG-containing solutions, point-of-care gastric ultrasound was performed to evaluate gastric contents and gastric volume before the induction of anesthesia.

Improved Intraoperative Hemodynamics in Burn Surgery: An Institutional Change to Pediatric-Specific Hemostasis Solutions.

A cornerstone of burn surgery hemostasis is infiltration of tumescent vasopressor solutions and topical vasoconstrictor-soaked compresses. Studies detailing pediatric-specific concentrations of these solutions are lacking. Our aim was to assess hemodynamic changes after an institutional change in tumescent vasopressor solution and vasopressor-soaked topical compresses for hemostasis management during pediatric burn surgery. Once the institutional change was implemented, cases performed before and after the intervention were reviewed; inclusion criteria included age 0 to 18 years, burn TBSA ≥ 10%, and surgery length > 50 minutes. Primary outcomes included changes in intraoperative mean arterial pressure, maximum inhaled anesthetic concentration, need for direct-acting vasodilators, estimated blood loss, and need for blood transfusions. Thirty patients were included in the intervention group, and 31 in the control group. There was a significant difference in peak intraoperative blood pressure in the intervention group (21.4%) compared with the control group (48.0%, P = .005). Maximum inhaled anesthetic concentrations were lower in the intervention group (2.5% vs 2.8%, P = .02). Estimated blood loss per TBSA decreased significantly (8.2 ml/1% TBSA vs 1.7, P = .008), as well as blood transfusion rates, with a transfusion rate of 16.7% in the intervention group vs 45.2% in the control group (P = .03). The changes instituted in type and concentration of tumescent solution and vasopressor-soaked topical compresses were associated with improved hemodynamic changes and decreased transfusion rates intraoperatively.