Problemi speciali
Il digiuno del bambino prima di una sedazione procedurale
Children’s fasting before procedural sedation
Arturo Penco1, FFrancesca Peri1, Federico Poropat2, Ester Conversano2, Egidio Barbi1,2, Giorgio Cozzi2
1Università di Trieste
2IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Novembre 2021 - pagg. 576 -582 | DOI: 10.53126/MEB40576
Abstract
Fasting before procedural sedation is a hot topic in everyday medical life with the main concern regarding pulmonary aspiration. Fasting guidelines before procedural sedation have always been the same as those used for general anaesthesia. However, procedural sedation and general anaesthesia differ in terms of invasiveness, drugs, duration and patient characteristics. This results in lower risk of pulmonary aspiration during procedural sedation, when compared to general anaesthesia. Moreover, a large case series of sedations performed in the emergency department with no respect for the proper fasting times showed no association between fasting duration and any type of adverse event with the latter occurring also in patients that properly fasted. The type of procedure (with the need of airway management) and characteristics of the patient seem to matter more. Furthermore, prolonged fasting is uncomfortable and has been associated with hypoglycaemia and dehydration. For this reason, fasting guidelines before procedural sedation should be adapted on the presence of risk factors, such as ASA score, need for airway management, comorbidities, type of procedure and drug used.
Riassunto
Il tempo di digiuno prima di una sedazione procedurale è un tema molto dibattuto nella quotidianità. Il motivo principale per cui viene adottato è per ridurre la frequenza dell’aspirazione polmonare. I tempi di digiuno prima di una sedazione procedurale sono da sempre uguali rispetto a quelli adottati per interventi in anestesia generale. Tuttavia sedazione procedurale e anestesia generale sono diversi per invasività, farmaci impiegati, durata e caratteristiche dei pazienti. Ciò si traduce in un rischio minore di aspirazione polmonare in corso di sedazione procedurale. Inoltre, non sembra esserci una correlazione chiara tra tempo di digiuno e aspirazione polmonare, sia perché ci sono ampie casistiche di sedazioni eseguite senza incidenti in emergenza senza attendere i tempi necessari di digiuno, sia perché diversi eventi avversi descritti in letteratura si sono verificati in pazienti a digiuno. Sembrano avere un peso maggiore, rispetto all’evento aspirazione polmonare, le caratteristiche della procedura (manipolazione delle vie aeree) e le caratteristiche del paziente. Il tempo di digiuno può protrarsi più a lungo rispetto alle linee guida, con possibili effetti avversi quali ipoglicemia e disidratazione. In questo articolo ripercorreremo le indicazioni attuali sui tempi di digiuno con particolare attenzione per quello che riguarda i fattori che possono influire sull’insorgenza di eventi avversi e sul setting della procedura.
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Corrispondenza: arturo.penco@gmail.com