Pre-procedural fasting in emergency sedation

Pre-procedural fasting for coronary interventions: is it time to change practice?

“…A review article by Thorpe et al 14 did not report any increased risk of pulmonary aspiration from not being fasted, in the emergency department. However, a prospective multicentre emergency department study of 2623 patients by Taylor et al 15 revealed 461 patients experienced at least one airway event requiring intervention.…”

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016

“…Several emergency department studies have reported a low to zero incidence of pulmonary aspiration despite variable fasting periods 260,264,268 ; however, each of these reports has, for the most part, clearly balanced the urgency of the procedure with the need for and depth of sedation. 268,269 Although emergency medicine studies and practice guidelines generally support a less restrictive approach to fasting for brief urgent/ emergent procedures, such as care of wounds, joint dislocation, chest tube placement, etc, in healthy children, further research in many thousands of patients would be desirable to better define the relationships between various fasting intervals and sedation complications. [262][263][264][265][266][267][268][269][270] …”

To feed or not to feed: Counterconditioning in the veterinary clinic

“…152the aspired fluids(Thorpe & Benger, 2010). However, pulmonary damage has been 153 demonstrated after both neutral and basic aspirations(Engelhardt & Webster, 1999), and 154 the volume of the aspired fluid is typically proportional to the gastric volume(Thorpe & 155 Benger, 2010).…”

“…It seems that airway reflexes are more or less unaffected during minimal and 167 moderate sedation, at least in humans, so perhaps it is only during deep sedation or general168 anesthesia that the risk of GER could potentially be increased(Thorpe & Benger, 2010) as169 long as vomiting does not occur. Also, in humans, two thirds of aspirations during anesthesia170 occur during intubation or extubation(Olsson et al, 1986), and vomiting is generally much 171 more common after general anesthesia than procedural sedation(Thorpe & Benger, 2010).172 The choice of premedication or light sedative agent is therefore important: since vomiting is 173 a predictor of AP in its own right, steps should be taken to avoid emetic compounds (see174 table 2). In addition, the choice of premedication may affect the risk of GER during 175 subsequent anesthesia(Wilson et al, 2007).…”