Preoperative fasting is routine practice before surgery and is intended to decrease the risk of aspiration. 1 Pulmonary aspiration of gastric content may occur through a combination of absent airway reflexes and passive regurgitation of gastric content during anesthesia. It can be catastrophic and lead to hypoxemia, prolonged ventilation, cardiac arrest or adverse airway events like bronchospasm and laryngospasm. 2 In pediatrics, this remains a rare event with incidences of 2-10 per 10 000 patients. 2 Prolonged fasting increases thirst and irritability, 3 and can result in detrimental metabolic effects such as hypoglycemia and ketoacidosis. 4 A clear fluid fasting policy down to 2 h often results in a mean of 7 h of fasting in practice. 5 Shortening fasting time to 1 h improves a child's metabolism and hemodynamic tolerance to induction of anesthesia, while decreasing postoperative nausea and opioid use. 2,4,6 Guidelines by North American and European anesthesiology organizations between 1998 and 2011 endorsed a rule of "6-4-2" hours of fasting for solids, breast milk, and clear fluids. 7,8 A 2016 review of

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