Chewing Gum = non-fasted?

Started by Emma Davey M.D., December 29, 2004, 02:18:22 AM

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Emma Davey M.D.

I had a 6 year old child who was fasted for all food and drinks for 6 hours for an elective procedure, except he had been chewing gum for 2 hours up until 15 minutes prior to his surgery. The nurses had told him and his parents that the anesthesiologist would cancel his surgery because of this.

I wasn't too fussed and proceeded, uneventfully. I can't imagine that chewing gum could generate enough saliva or even gastric fluids sufficient to cause a risk of aspiration. I did a quick literature check but found nothing.

Anyone care to enlighten me?


Matthew Parsons

For purely elective surgery I would postpone any child who has been chewing gum. The act of chewing not only results in large amounts of saliva production (and swallowing) but also gastric fluid secretion by the stomach. Chewing gum increases gastric volume and decreases gastric pH. It increases the risk of dangerous aspiration.

No,I have no evidence for this except basic physiology. However, from a medicolegal point of view, you would be crazy to proceed. Imaging if the child did aspirate (whether or not the chewing gum contributed). How could you defend yourself?

Ahmad Menari

While I have no information about the incidence of reflux/aspiration in people who chew gum, I know of 2 cases where chewing gum was found incidentally in children after induction. In one case, the gum was found during intubation and removed, but in the second case the chewing gum was not seen. It was only discovered after extubation when it caused a glottic obstruction and the child needed to be re-intubated and was found at laryngoscopy.

Matthew Parsons

Our pre-admission clinic explicitly states to all patients not eat, drink, (even water or tea), chew gum. Parents are reminded to observe children in the pre-operative period to ensure the children are fasted.

This reminder is given verbally and in a printed flyer.