Preoperative fasting for ambulatory cataract surgery: a systematic review

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

“…Procedural sedation is regularly performed in other settings in which fasting is frequently incomplete: cardiac catheterisation [80]; therapeutic abortions [81]; eye surgery [82][83][84][85]; and abdominal imaging in children who have first received oral contrast [86][87][88]. None of these settings have been identified as showing an increased aspiration risk.…”

Safety of low-dose propofol in non-fasted patients undergoing cataract surgery: a prospective cohort study

“…We note that their conclusions are based on results from 42 articles, only two of which involved patients with a median age >80 yr, as might be expected in most Western hip fracture populations. 2,3 The authors acknowledge the difficulty in defining both absolute and relative thresholds for intraoperative hypotension, below which patients are at increased risk of death and end organ-specific injury (brain, heart, kidneys), particularly with increasing duration of hypotension. Ke and colleagues 4 also recognise this difficulty in their accompanying editorial, echoing previous commentary by Brady and Hogue.…”

“…5 Their quoted MAP thresholds for 'shorter' durations (<10 min) and 'any' duration are low (<70 mm Hg and <55e50 mm Hg, respectively, occurring at monitored BPs of~90/60 mm Hg and 80/40 mm Hg), but are breached nevertheless in 79% and 32% of hip fracture patients, respectively. 2 Sessler and colleagues 6 have recently concluded that 'even brief durations of systolic arterial pressure <100 mm Hg … are harmful during noncardiac surgery', but even this threshold is breached in 77% of hip fracture patients. 2 As the authors acknowledge, however, a broad range of nadir pressures occur around these thresholds intraoperatively, potentially exposing older patients to greater harm than those quantified in predominantly younger patient populations.…”

“…2 Sessler and colleagues 6 have recently concluded that 'even brief durations of systolic arterial pressure <100 mm Hg … are harmful during noncardiac surgery', but even this threshold is breached in 77% of hip fracture patients. 2 As the authors acknowledge, however, a broad range of nadir pressures occur around these thresholds intraoperatively, potentially exposing older patients to greater harm than those quantified in predominantly younger patient populations. A population threshold pressure assumes that all patients studied autoregulate equally at that pressure, but the 'older' elderly are less able to autoregulate critical organ perfusion at lower BPs, 7 consequent to their age, polypharmacy and frailty.…”

“…The effect of conscious sedation has mainly been studied with benzodiazepines or opioids in starving patients undergoing cataract surgery. 2 In our outpatient ophthalmologic department, a new ophthalmologist-led cataract pathway allows unrestricted access to surgery for patients, regardless of comorbidities or physical condition, with anaesthesia support when required. We performed a prospective analysis to estimate the incidence of anaesthesia-related complications and posterior capsular disruption after administration of low-dose propofol among non-fasting patients during cataract surgery performed under topical anaesthesia.…”