In this episode, we will be welcoming Dr. Maala Bhatt, the Associate Professor of Pediatrics at the University of Ottawa. She is the Research Director for the Division of Emergency Medicine and a pediatric emergency medicine physician at the Children’s Hospital of Eastern Ontario (CHEO). She is a member of the Society for Pediatric Sedation. She led the development of the first standardized definitions for procedural sedation and has published the largest emergency department procedural sedation cohort, establishing practices associated with the safest sedation outcomes. 

Her primary research interest is in the safety of emergencies department procedural sedation. She has published multiple articles and peer review journals on sedation related topics including on fasting before procedural sedation. The first patient case scenario is of an eighteen month old girl scheduled for a brain MRI for a focal seizure which occurred three days ago, and her parents are asking if they have to keep their NPO for so long and whether there is any science behind this practice of fasting before sedation. 

The second case is one of a seven year old boy with a forearm fracture which requires redaction and casting under procedural sedation. The patient had eaten a peanut butter sandwich an hour before the fall. Join us as we dive into this insightful discussion with Dr. Bhatt on fasting before procedural sedation and how previous fasting guidelines came about, and what is changing about that. Enjoy!

Show Highlights

• Our understanding of aspiration and its risk factors with respect to the history of fasting guidelines (02:16)
• The risk for aspiration during procedural sedation (04:52)
• The aspiration risk for children prior to sedation when drinking clear liquids (05:38)
• Advantages and disadvantages of prolonged fasting in children with respect to clear liquids (06:51)
• Current guidelines being followed today in procedural sedation (08:31)
• The association between pre-procedural fasting duration and the incidence of sedation related adverse outcomes during emergency department sedation of children (10:43)
• Dr. Bhatt’s thoughts on the 2016 study reporting on the association between aspiration and patient and procedure factors (12:26)
• Changes in practice that may come about from different publications stating that fasting is not a risk factor for aspiration (15:46)
• Understanding that NPO time on its own is not a predictor for aspiration (17:45)

Additional Resources

• Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children