Pre‐operative fasting guidelines: an update

Abstract

Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children <6 months, most recommendations now allow breast-or formula milk feeding up to 4 h before anaesthesia. Recently, the concept of pre-operative oral nutrition using a special carbohydrate-rich beverage has also gained support and been shown not to increase gastric fluid volume or acidity. Based on the available literature, our Task Force has produced new consensus-based Scandinavian guidelines for pre-operative fasting. What is still not clear is to what extent the new liberal fasting routines should apply to patients with functional dyspepsia or systematic diseases such as diabetes mellitus. Other still controversial areas include the need for and effect of fasting in emergency patients, women in labour and in association with procedures done under 'deep sedation'. We think more research on the effect of various fasting regimes in subpopulations of patients is needed before we can move one step further towards completely evidence-based pre-operative fasting guidelines. Accepted for publication 16 March 2005Key words: Anaesthesia; general; gastric content; gastric emptying; preoperative fasting; pulmonary aspiration complications. # Acta Anaesthesiologica Scandinavica 49 (2005)A NAESTHESIA-RELATED pulmonary aspiration leading to respiratory failure (Aspiration Pneumonitis; Mendelson's syndrome) has been described in both elective and emergency surgical patients (1-7). With the hope of reducing the risk of this complication, rigid fasting routines before surgery have been enforced (8). However, the scientific basis for these rigid fasting routines in elective patients has been challenged and found to be nonexistent (9-11). Based on this new information, several national anaesthesia societies now have accepted more liberal fasting rules for clear fluids (water, clear juices, coffee, tea) (12-17). Intake of solids in the morning of elective surgery is still not recommended.To what extent pre-operative fasting is of any importance in emergency cases is still a matter of uncertainty with variation in clinical practice. Further, it is also not clear to what extent specific patient populations with suspected or proven delayed gastric emptying need to be exempt from the new fasting guidelines (16,17). Recently, a new method for pre-operative optimization of the elective patient, oral nutrition with carbohydrates (16,18,19), has been introduced, but so far has not been widely implemented into clinical practice.This review aims to give an update on preoperative fasting and gastric content as a risk factor of pulmonary aspiration. We will focus on the development and experience with the new and more liberal clinical practice guidelines, but also present still controversial areas worth further research. Anaesthesia-related pulmonary aspiration: risk factors Gastric e...

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

“…However, for minor surgery the benefit is mainly in patient well‐being,41 and in other types of surgeries the data remain sparse 44. Many National and International Anaesthetic Societies recommend a 6‐h pre‐operative fast for solids and a 2‐h fast for clear liquids, including carbohydrate drinks 44, 45, 46, 47…”

The Effect of Preoperative Oral Carbohydrate Loading on Stress Response in Patients Undergoing Major or Minor Surgery

“…1,2 Bu na kar şın yıl lar için de elek tif gi rişim ler de ka tı aç lık ku ral la rı nın as pi ras yon ris ki ni et ki le me di ği yö nün de so nuç lar bil di ril me si ile özel-lik le ber rak sı vı alı mı ile il gi li ku ral lar de ğiş me ye baş la mış tır. Ran do mi ze kon trol lü ça lış ma lar ve meta a na liz ler de su ve di ğer ber rak sı vı la rın anes te zi in dük si yo nun dan iki sa at ön ce si ne ka dar alın ma sı -nın, gas trik sı vı hac mi ve asi di te si ni art tır ma dı ğı ve as pi ras yon açı sın dan sa kın ca lı ol ma dı ğı bil di rilmiş tir.…”

“…Pre o pe ra tif aç lık sü-re si ve cer ra hi gi ri şim tü rü nün aç lı ğın oluş tur du ğu ka ta bo lik ce vap ve in sü lin di ren ci ni et ki le di ği bilin mek te dir. 2,9,10 Cer ra hi gi ri şim ön ce si karbonhidrat alı mı nın; ope ras yon son ra sı in sü lin di ren ci ni dü şür dü ğü, endo jen glu koz sa lı nı mı nı azalt tı ğı, kas lar da gli ko jen sen te zi ni azalt tı ğı, aç bı ra kı lan has ta la ra gö re in sü -lin du yar lı lı ğı nı da ha az azalt tı ğı ile ri sü rül müş -tür. [11][12][13] Pre o pe ra tif nüt ris yon ama cıy la ge liş ti ri len oral glu koz so lüs yon la rı ope ras yon dan iki sa at ön-ce si ne ka dar kul la nı la bil mek te dir ler.…”

Hyperergic Aspiration Pneumonitis (Mendelson Syndrome)

“…Многочисленные контролируемые иссле дования и метаанализ привели к заключению, О б з о р ы что у пациентов, которым планируется провести плановые оперативные вмешательства, прием воды или других чистых жидкостей (чай, кофе, содовая, яблочный и апельсиновый сок без мя коти) более чем за 2 часа перед введением в нар коз не увеличивает объем желудочного сока и кислотность [36][37][38][39][40][41][42][43][44][45][46][47][48]. Исследования проводили в разных странах на взрослых мужчинах и жен щинах (совершеннолетних).…”

“…Период голодания после приема твердой пищи должен быть не менее 6 часов для обеспече ния существенной безопасности [38,[42][43][44]. Ис пользование жевательной резинки, табака увели чивает объем содержимого желудка, но пока не ясно, до каких пределов это увеличение является клинически значимым [37,45]. В настоящий мо мент мы считаем, что их использование следует прекратить в предоперационном периоде.…”