Real-world fasting practice, airway management patterns, and pulmonary aspiration risk in pediatric anesthesia: a 10-year cohort of 3230 anesthetics

Real-world fasting practice, airway management patterns, and pulmonary aspiration risk in pediatric anesthesia: a 10-year cohort of 3230 anesthetics | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Real-world fasting practice, airway management patterns, and pulmonary aspiration risk in pediatric anesthesia: a 10-year cohort of 3230 anesthetics Liming Zhang¹, Shan Huang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9095597/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Pulmonary aspiration is a rare but potentially serious complication of pediatric anesthesia. Concerns regarding aspiration risk continue to influence perioperative decision-making, particularly with respect to fasting policies and airway management strategies. However, real-world clinical practice often differs from guideline recommendations [1,2]. Methods We conducted a retrospective cohort study of pediatric patients undergoing anesthesia at a tertiary pediatric hospital over a 10-year period. Data were extracted from the institutional anesthesia database and electronic medical records. Variables included patient demographics, surgical category, fasting duration, last intake type, airway management technique, and aspiration-related events. Results A total of 3230 pediatric anesthetics were included. The median age was 4.61 years (IQR 2.1–8.0) . The median fasting duration was 5.19 hours (IQR 3.91–6.47) and 65.8% of patients fasted less than 6 hours . Supraglottic airway devices were used in 2763 cases (85.6%) , while 467 cases (14.4%) underwent primary endotracheal intubation. Conversion from supraglottic airway to tracheal intubation occurred in 93 cases (3.4%) . No intraoperative pulmonary aspiration events were observed. One intraoperative regurgitation event occurred without pulmonary complications. Two aspiration events occurred in the ward several hours after postoperative feeding. With zero intraoperative aspiration events in 3230 anesthetics, the upper bound of the 95% confidence interval estimated using the rule-of-three method was approximately 0.93 per 1000 anesthetics [13]. Conclusions In this 10-year cohort of pediatric anesthetics, no intraoperative pulmonary aspiration events were observed despite relatively short fasting durations and widespread use of supraglottic airway devices . Aspiration events occurred only after postoperative feeding, suggesting that perioperative vigilance should extend beyond the operating room to the postoperative recovery period . pediatric anesthesia pulmonary aspiration fasting practice supraglottic airway perioperative safety Full Text Additional Declarations No competing interests reported. Table 1 to 5 are available in the Supplementary Files section. Supplementary Files table15.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9095597","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":608443141,"identity":"0f060150-121c-49b1-8f00-30d4978c4a16","order_by":0,"name":"Liming Zhang¹","email":"","orcid":"","institution":"Wuhan Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Liming","middleName":"","lastName":"Zhang¹","suffix":""},{"id":608443142,"identity":"0f83d230-a32c-42cb-8598-7fd5fb4e3783","order_by":1,"name":"Shan Huang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBACAwglIcfP3nzgwIcfxGuxMZbsOZZ4cGYP8VrSEjfcyDE+zMFGhBZz/tNpUjfbDhsznDnz4TADD4M8v9gB/FosZ+Ruk85tOyzH2N674XCBBYPhzNkJBBx2gxesxZiZ5+yGwzN4GBIMbhPScv4sWEtim0TOg8M8bMRoOQB2WFpij0QOA5FabuRuts45Z2MswXPMABjIEkT45fzZjbdzyiTk7I83P/7w4YeNPL80AS3oQII05aNgFIyCUTAKsAMAqONKvuzhhacAAAAASUVORK5CYII=","orcid":"","institution":"Wuhan Children’s Hospital","correspondingAuthor":true,"prefix":"","firstName":"Shan","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2026-03-11 14:25:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9095597/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9095597/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105213657,"identity":"39a7e135-8aed-486b-9038-2e3c7955bdc9","added_by":"auto","created_at":"2026-03-23 14:13:03","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":236619,"visible":true,"origin":"","legend":"","description":"","filename":"BMC.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9095597/v1_covered_86f17817-9d8f-4324-88fd-0f65ac32243b.pdf"},{"id":105007737,"identity":"22877b82-68c7-4333-a817-76e60a386cd2","added_by":"auto","created_at":"2026-03-19 19:03:11","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16346,"visible":true,"origin":"","legend":"","description":"","filename":"table15.docx","url":"https://assets-eu.researchsquare.com/files/rs-9095597/v1/0a2af05ad12beca09be70678.docx"}],"financialInterests":"\u003cp\u003eNo competing interests reported.\u003c/p\u003e\n\u003cp\u003eTable 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e","formattedTitle":"Real-world fasting practice, airway management patterns, and pulmonary aspiration risk in pediatric anesthesia: a 10-year cohort of 3230 anesthetics","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pediatric anesthesia, pulmonary aspiration, fasting practice, supraglottic airway, perioperative safety","lastPublishedDoi":"10.21203/rs.3.rs-9095597/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9095597/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePulmonary aspiration is a rare but potentially serious complication of pediatric anesthesia. Concerns regarding aspiration risk continue to influence perioperative decision-making, particularly with respect to fasting policies and airway management strategies. However, real-world clinical practice often differs from guideline recommendations [1,2].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a retrospective cohort study of pediatric patients undergoing anesthesia at a tertiary pediatric hospital over a 10-year period. Data were extracted from the institutional anesthesia database and electronic medical records. Variables included patient demographics, surgical category, fasting duration, last intake type, airway management technique, and aspiration-related events.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of \u003cstrong\u003e3230 pediatric anesthetics\u003c/strong\u003e were included. The median age was \u003cstrong\u003e4.61 years (IQR 2.1–8.0)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eThe \u003cstrong\u003emedian fasting duration was 5.19 hours (IQR 3.91–6.47)\u003c/strong\u003e and \u003cstrong\u003e65.8% of patients fasted less than 6 hours\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupraglottic airway devices were used in 2763 cases (85.6%)\u003c/strong\u003e, while \u003cstrong\u003e467 cases (14.4%)\u003c/strong\u003e underwent primary endotracheal intubation. Conversion from supraglottic airway to tracheal intubation occurred in \u003cstrong\u003e93 cases (3.4%)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo intraoperative pulmonary aspiration events were observed.\u003c/strong\u003e One intraoperative regurgitation event occurred without pulmonary complications.\u003c/p\u003e\n\u003cp\u003eTwo aspiration events occurred in the ward several hours after postoperative feeding.\u003c/p\u003e\n\u003cp\u003eWith zero intraoperative aspiration events in 3230 anesthetics, the upper bound of the \u003cstrong\u003e95% confidence interval estimated using the rule-of-three method was approximately 0.93 per 1000 anesthetics\u003c/strong\u003e [13].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this 10-year cohort of pediatric anesthetics, \u003cstrong\u003eno intraoperative pulmonary aspiration events were observed despite relatively short fasting durations and widespread use of supraglottic airway devices\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eAspiration events occurred only after postoperative feeding, suggesting that \u003cstrong\u003eperioperative vigilance should extend beyond the operating room to the postoperative recovery period\u003c/strong\u003e.\u003c/p\u003e","manuscriptTitle":"Real-world fasting practice, airway management patterns, and pulmonary aspiration risk in pediatric anesthesia: a 10-year cohort of 3230 anesthetics","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 19:03:07","doi":"10.21203/rs.3.rs-9095597/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e05883cc-f2ae-47e9-a8c7-319642f79e0a","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T14:11:23+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 19:03:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9095597","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9095597","identity":"rs-9095597","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}